Heart transplantation graft survival following donation after circulatory death via thoracoabdominal normothermic regional perfusion.

Background: The impact of thoracoabdominal normothermic regional perfusion (TA-NRP) use in donation after circulatory death (DCD) on rates of graft survival after heart transplantation has yet to be established. Methods: A cohort study of the Scientific Registry of Transplant Recipients was performed identifying all primary adult heart transplants performed in the United States between January 1, 2020, and May 31, 2024, comparing donation after brain death (DBD), DCD with direct procurement and perfusion (DPP) (defined as declaration of circulatory death to cross clamp <30 min), and DCD with TA-NRP (defined as declaration of circulatory death to cross clamp >40 min). The primary outcome was graft loss (re-transplant or death). Results: There were 474 (3.5%) DCD TA-NRP, 899 (6.6%) DCD DPP, and 12,185 (89.9%) DBD heart transplants during the study period, with varying donor and baseline characteristics, including more male and non-Hispanic White DCD TA-NRP recipients, and fewer DCD TA-NRP recipients listed as Status 1. On multivariable analysis, graft survival rates did not significantly differ between cohorts [Adjusted Hazard Ratio (aHR) (95% CI): 0.98 (0.70, 1.37) for DCD TA-NRP vs. DBD; and 1.04 (0.69, 1.56) for DCD TA-NRP vs. DCD DPP]. Conclusion: DCD TA-NRP recovery in heart transplantation yields comparable rates of two-year graft survival compared to DCD DPP and DBD recovery, supporting greater utilization of TA-NRP recovery in DCD allografts.