Post-transplant survival after normothermic regional perfusion vs direct procurement and perfusion in donation after circulatory determination of death heart transplantation

Authors

Gege Ran, Pritzker School of Medicine, University of Chicago, Chicago, IL.
Anji E. Wall, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
Nikhil Narang, Advocate Health - MidwestFollow
Kiran K. Khush, Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA.
Jordan R. Hoffman, Division of Cardiothoracic Surgery, University of Colorado, Aurora, CO.
Kevin C. Zhang, Department of Medicine, University of Chicago, Chicago, IL.
William F. Parker, Department of Medicine, University of Chicago, Chicago, IL; Department of Public Health Sciences, University of Chicago, Chicago, IL; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL. Electronic address: wparker@uchicago.edu.

Recommended Citation

Ran G, Wall AE, Narang N, et al. Post-transplant survival after normothermic regional perfusion versus direct procurement and perfusion in donation after circulatory determination of death in heart transplantation. J Heart Lung Transplant. 2024;43(6):954-962. doi:10.1016/j.healun.2024.02.1456

Affiliations

Advocate Christ Medical Center

Abstract

Background:Since 2019, the annual transplantation rate of hearts donated following circulatory death (DCD) has increased significantly in the United States. The two major heart procurement techniques following circulatory death are direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). Post-transplant survival for heart recipients has not been compared between these two techniques.

Methods:This observational study uses data on adult heart transplants from donors after circulatory death from January 1, 2019, to December 31, 2021, in the Scientific Registry of Transplant Recipients. We identified comparable transplant cases across procurement types using propensity-score matching and measured the association between procurement technique and 1-year post-transplant survival using Kaplan-Meier and mixed-effect Cox proportional hazards models with random intercepts for each center.

Results:Among 318 DCD heart transplants, 216 (68%) were procured via DPP, and 102 (32%) via NRP. Among 22 transplant centers that accepted circulatory-death donors, 3 used NRP exclusively, and 5 used both procurement techniques. After propensity-score matching on recipient and donor factors, there was no significant difference in one-year post-transplant survival (93.1% for NRP vs 91.1% for DPP, p = 0.79) between procurement techniques.

Conclusions:NRP and DPP procurements are associated with similar one-year post-transplant survival. If NRP is ethically permissible and improves outcomes for abdominal organs, it should be the preferred procurement technique for DCD hearts.

Data availability statement:The data that support the findings of this study are available from the Scientific Registry of Transplant Recipients (SRTR). Restrictions apply to the availability of these data, which were used under license for this study.

Document Type

Article

PubMed ID

38423416