Emerging National Trends in Normothermic Regional Perfusion for Simultaneous Pancreas-Kidney Transplantation

Normothermic regional perfusion (NRP) is rapidly gaining adoption for donation after cardiac death (DCD) organ recovery in the United States. However, little is known about trends in NRP procured grafts for simultaneous pancreas-kidney transplantation (SPK).

SPK recipients between January 2021 and June 2025 were identified using the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) national data.

DCD-SPK donors and recipients were included and grouped by recovery method.

Donor and recipient demographic data were described. Primary outcomes were pancreas and kidney graft survival at 1 year, evaluated with Kaplan-Meier survival curves. Kidney outcomes included delayed graft function and creatinine levels.

A total of 137 DCD SPKs were included, with NRP and super-rapid recovery (SRR) performed in 33 (24%) and 104 (76%) of donors, respectively. Donors in the NRP group were older (28 [22-34] vs. 22 [18-29], p < 0.05) and had a longer withdrawal-to-death time (22 [18-24] vs. 18 [15-22], p < 0.05). Recipients in the NRP group were younger (38 [35-46] vs. 48 [39-55], p < 0.05), more frequently transplanted for Type 1 diabetes, and had worse functional status at the time of transplant. NRP was associated with lower rates of delayed kidney graft function (6% vs. 33%, p < 0.05) and a trend toward lower 6-month creatinine (1.1 vs. 1.3 mg/dL, p = 0.054), with similar 1-year values. One-year pancreas and kidney graft survival following NRP were 91% and 100%, respectively.

Since the introduction of NRP, 24% of the DCD-SPK grafts were procured with NRP. Comparable 1-year kidney and pancreas graft survival between SRR and NRP with lower rates of kidney dysfunction following NRP.