The Journal of thoracic and cardiovascular surgery · 2026
Pick your perfusion: National outcomes of normothermic regional perfusion versus direct procurement and perfusion in donation after circulatory death cardiac transplants.
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Shou Benjamin L, Goerlich Corbin E, Zhou Alice L, Ruaengsri Chawannuch, Shudo Yasuhiro, Hiesinger William
Аннотация
OBJECTIVE: Donation after circulatory death cardiac transplantation has substantially expanded the donor pool; however, the optimal procurement strategy (direct procurement and perfusion or normothermic regional perfusion) remains actively debated. We compared contemporary national outcomes of normothermic regional perfusion versus direct procurement and perfusion using the United Network for Organ Sharing registry.
METHODS: We analyzed first-time, isolated adult donation after circulatory death heart transplants performed in the United States between January 1, 2019, and March 31, 2026, using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Direct procurement and perfusion and normothermic regional perfusion were defined as a death-to-crossclamp interval 30 minutes or less and more than 30 minutes, respectively. Primary outcomes were 1-month, 1-year, and 3-year all-cause mortality. One-to-one propensity score matching was performed to compare differences in outcomes between direct procurement and perfusion and normothermic regional perfusion.
RESULTS: The analytic cohort comprised 2831 donation after circulatory death heart transplant recipients: 1737 (61.4%) direct procurement and perfusion and 1094 (38.6%) normothermic regional perfusion. Donation after circulatory death comprised 24.6% of all adult heart transplants performed in the United States in 2025. After propensity score matching, 939 direct procurement and perfusion and normothermic regional perfusion pairs were identified. In the matched cohort, survival was lower after direct procurement and perfusion than after normothermic regional perfusion at 1 month (95.8% vs 97.9%; P = .01), 1 year (90% vs 92%, P = .05), and 3 years (83.5% vs 86.9%, P = .04). One-year survival was similar for those surviving the first month (94.0% for both groups), as was 3-year survival conditional on surviving 1 year (92.7% vs 94.4%, P = .52).
CONCLUSIONS: Normothermic regional perfusion was associated with a modest short-term perioperative survival benefit compared with direct procurement and perfusion. Among recipients who survived the first month and year, 1- and 3-year survivals were similar, respectively.
METHODS: We analyzed first-time, isolated adult donation after circulatory death heart transplants performed in the United States between January 1, 2019, and March 31, 2026, using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Direct procurement and perfusion and normothermic regional perfusion were defined as a death-to-crossclamp interval 30 minutes or less and more than 30 minutes, respectively. Primary outcomes were 1-month, 1-year, and 3-year all-cause mortality. One-to-one propensity score matching was performed to compare differences in outcomes between direct procurement and perfusion and normothermic regional perfusion.
RESULTS: The analytic cohort comprised 2831 donation after circulatory death heart transplant recipients: 1737 (61.4%) direct procurement and perfusion and 1094 (38.6%) normothermic regional perfusion. Donation after circulatory death comprised 24.6% of all adult heart transplants performed in the United States in 2025. After propensity score matching, 939 direct procurement and perfusion and normothermic regional perfusion pairs were identified. In the matched cohort, survival was lower after direct procurement and perfusion than after normothermic regional perfusion at 1 month (95.8% vs 97.9%; P = .01), 1 year (90% vs 92%, P = .05), and 3 years (83.5% vs 86.9%, P = .04). One-year survival was similar for those surviving the first month (94.0% for both groups), as was 3-year survival conditional on surviving 1 year (92.7% vs 94.4%, P = .52).
CONCLUSIONS: Normothermic regional perfusion was associated with a modest short-term perioperative survival benefit compared with direct procurement and perfusion. Among recipients who survived the first month and year, 1- and 3-year survivals were similar, respectively.