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. 2025 May 26:9:100289.
doi: 10.1016/j.jhlto.2025.100289. eCollection 2025 Aug.

Donation after circulatory death with thoracoabdominal normothermic regional perfusion recovery has similar outcomes with donation after brain death for lung transplantation

Sarah Y Park  1 , Emily Hay-Arthur  1 , Elizabeth J Bashian  1 , Han Le  1 , Michal Schäfer  1 , David N Campbell  1 , Nicholas R Teman  1 , Alice L Gray  2 , Jordan R H Hoffman  1 , Michael T Cain  1
Affiliations

Donation after circulatory death with thoracoabdominal normothermic regional perfusion recovery has similar outcomes with donation after brain death for lung transplantation

Sarah Y Park et al. JHLT Open. .

Abstract

Introduction: Donation after circulatory death (DCD) with thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly used to procure cardiac allografts; however, concerns persist regarding its impact on lung allografts. We present our institution's experience with DCD TA-NRP and donation after brain death (DBD) lung transplants, comparing outcomes between the two techniques.

Methods: All lung transplants recovered with DBD or DCD TA-NRP performed between October 2022 and December 2024 were included. DCD TA-NRP procured lungs were retrieved using a lung protective strategy including early reintubation and pulmonary venting as previously described. The primary outcome was survival, with secondary outcomes of primary graft dysfunction (PGD) and pulmonary-related mortality.

Results: There were 85 DBD and 23 DCD TA-NRP lung transplants performed in the study period. Overall survival was not significantly different by Kaplan-Meier curve (p = 0.49), with 1-year absolute survival of 81.6% for DCD TA-NRP, with only one pulmonary-related mortality, and 89.4% for DBD, with six pulmonary-related mortalities. PGD grade 3 rates were not statistically different at postoperative day (POD) 0 (47.8% DCD TA-NRP vs 35.2% DBD, p = 0.27), POD 1 (21.7% vs 10.6%, p = 0.16), POD2 (8.7% vs 11.7%, p = 0.68), and POD3 (13.0% vs 11.8%, p = 0.87). Other intraoperative and postoperative outcomes were not significantly different.

Conclusion: Lung transplantation outcomes were not significantly different between lung grafts recovered by DCD TA-NRP and DBD. This early data suggests TA-NRP may not adversely impact DCD lung allografts during procurement.

Keywords: Donation after brain death; Donation after circulatory death; Lung transplantation; Normothermic regional perfusion; Primary graft dysfunction.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves comparing DCD TA-NRP and DBD recovered lung transplants with 95% CI error bars. Number at risk included at 30 days, 90 days, 6 months, 1 year, and 2 years.
Figure 2
Figure 2
Mortality/survival rates based on time stratified by years since start of TA-NRP recovery of DCD lungs at our center.
Figure 3
Figure 3
Sankey Diagram depicting PGD at 0, 24, 48, and 72 hours after transplant comparing (a) DCD TA-NRP and (b) DBD lung transplants*. *One DBD lung transplant patient’s 72-hour PGD was not recorded in their chart and therefore not included in the Sankey diagram.
See this image and copyright information in PMC

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