Noncardiac Normothermic Regional Perfusion in Circulatory Death Donors may Improve Kidney Utilization and Prevent...

Cardiac Normothermic regional perfusion (NRP) was introduced in the United States in 2020, driven primarily by heart transplant teams. More recently, noncardiac NRP, a technique widely used in several European countries, has emerged as an alternative, providing regional in situ perfusion restricted to abdominal organs. This study aimed to quantify the association of noncardiac NRP on kidney utilization and post-transplant outcomes, compared with super-rapid recovery (SRR) and cardiac NRP.

Using the United Network for Organ Sharing database, donation after circulatory death (DCD) donors and recipients from 2020 to 2024 were analyzed. Donors were categorized as SRR, noncardiac NRP, or cardiac NRP groups.

Among 20,531 DCD donors, 93.2% underwent SRR, 5.3% noncardiac NRP, and 1.4% cardiac NRP. The use of noncardiac NRP increased sharply from <1% in 2020 to 23.1% in 2024. Noncardiac NRP donors were older (51 y versus 50 y versus 33 y, P < 0.001) and had higher kidney donor profile index (KDPI) scores (54 versus 51 versus 24, P < 0.001) compared to SRR and cardiac NRP, respectively. Noncardiac NRP was associated with a higher likelihood of kidney utilization compared to SRR (adjusted odds ratio (OR): 1.31, 95% CI: 1.11-1.55, P = 0.001). Post-transplant outcomes showed significantly lower delayed graft function rates in the noncardiac NRP group (24.1%) compared to SRR (44.8%), with similar outcomes to cardiac NRP (16.6%).

Noncardiac NRP offers significant advantages over SRR in terms of kidney utilization and post-transplant outcomes, with comparable results to cardiac NRP. The increasing adoption of noncardiac NRP underscores its potential to address the kidney donor shortage and improve transplantation outcomes.