Reanimationless Rapid Recovery Versus Thoraco-Abdominal Normothermic Regional Perfusion for Donation After Circulatory Death Heart Transplantation Following Prolonged Asystolic Warm Ischemia.

BACKGROUND

Donation after circulatory death (DCD) heart transplantation has expanded the donor pool, yet contemporary recovery strategies remain constrained. Rapid Recovery with Extended Ultra-Oxygenated Preservation (REUP) is a non-reanimation DCD recovery strategy that eliminates the need for donor heart reperfusion prior to transplantation. As prolonged asystolic warm ischemic time (AWIT) during circulatory arrest has raised ongoing concerns, whether REUP achieves outcomes comparable to TA-NRP in DCD donors with prolonged AWIT remains unknown.

METHODS

We performed a retrospective single-center study of DCD heart transplant recipients whose donor hearts were recovered using either TA-NRP or REUP and preserved with 10°C static cold storage. Donors with AWIT <10 minutes were excluded. The primary outcomes were severe primary graft dysfunction (PGD) and 90-day mortality.

RESULTS

Eighty-two DCD heart transplant recipients met inclusion criteria, including 55 TA-NRP and 27 REUP recipients. Compared with TA-NRP donors, REUP donors were older (42.0 vs 33.7 years) and experienced longer total ischemic times (285 vs 219 minutes). Severe PGD occurred in 4 TA-NRP recipients (7.3%) and no REUP recipients (0.0%). Ninety-day mortality was 12.7% versus 7.4%, respectively. In weighted bootstrap analyses, REUP was associated with a directional signal toward lower severe PGD (OR 0.22, 95% CI 0.09-1.02; directional consistency 97.4%) and lower 90-day mortality (OR 0.56, 95% CI 0.09-2.57; directional consistency 76.3%), although confidence intervals were wide.

CONCLUSIONS

Among DCD heart transplant recipients with AWIT ≥10 minutes, REUP demonstrated early graft function and short-term survival comparable to TA-NRP despite a more challenging donor profile. These findings support further prospective multicenter evaluation of REUP as a broadly deployable non-reanimation DCD heart recovery strategy.