Related Experiment Video
Updated: May 26, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
DCDD heart transplantation with thoraco-abdominal normothermic regional perfusion and static cold storage: The
Alicia Pérez-Blanco1, Francisco González-Vilchez2, José González-Costello3
1Organización Nacional de Trasplantes, Madrid, Spain.
Insights
Heart transplants using donation after circulatory determination of death (DCDD) hearts, enabled by normothermic regional perfusion (TA-NRP), show similar short-term outcomes to donation after neurologic determination of death (DNDD) heart transplants.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Donation after circulatory determination of death (DCDD) heart transplantation is growing globally.
- Normothermic regional perfusion (TA-NRP) facilitates DCDD heart recovery, but evidence on transplant outcomes is limited.
Purpose of the Study:
- To evaluate the short-term outcomes of adult DCDD heart transplants using TA-NRP and static cold storage.
- To compare these outcomes with heart transplants from donors after neurologic determination of death (DNDD).
Main Methods:
- A prospective, multicenter, nationwide study in Spain (2020-2023).
- Included 98 adult DCDD heart transplants and 347 DNDD heart transplants (controls).
- Primary outcome: composite of 1-year all-cause death or severe primary graft failure.
Main Results:
- No significant difference in the primary outcome between DCDD and DNDD groups (21.4% vs 22.2%, P = .87).
- Similar 30-day and 1-year survival rates (94.9% vs 93.7% and 88.8% vs 87.3%, respectively).
- Comparable rates of severe primary graft failure (13.3% vs 15.0%).
Conclusions:
- Adult DCDD heart transplantation utilizing TA-NRP and static cold storage yields comparable short-term results to DNDD heart transplantation.
- This approach supports the viability of DCDD hearts for transplantation.
Abstract:
Heart transplantation from donors after the circulatory determination of death is expanding worldwide. Thoraco-abdominal normothermic regional perfusion (TA-NRP) allows the validation and recovery of the donation after the circulatory determination of death (DCDD) heart, but there is limited evidence on the results of heart transplants performed with this approach. This multicenter, nationwide, prospective study describes the short-term outcomes of adult patients receiving a DCDD heart transplant obtained via TA-NRP followed by static cold storage in Spain. Recipients of hearts from donors after the neurologic determination of death were used as controls. The primary outcome was a composite of 1-year all-cause death or severe primary graft failure. During 2020-2023, 98 adult DCDD and 347 donations after the neurologic determination of death (DNDD) heart transplants were performed across 11 centers. The primary outcome was met by 21 (21.4%) and 77 (22.2%) patients, respectively (P = .87). Thirty-day and 1-year survival were 94.9% and 88.8% in the DCDD vs 93.7% and 87.3% in the DNDD group (P = .70), respectively. Severe primary graft failure was observed in 13 (13.3%) vs 52 (15.0%) patients (P = .67). By inverse probability weighting, the DCDD heart was not associated with the primary outcome (hazard ratio, 0.97; 95% confidence interval, 0.58-1.62; P = .91). In conclusion, adult DCDD heart transplantation based on TA-NRP and static cold storage provides similar short-term outcomes than DNDD heart transplants.
