Normothermic Regional Perfusion in Donation after Circulatory Death Heart Donors May Not Have a Detrimental Effect on Lung Transplant Outcomes.

Normothermic regional perfusion is increasingly used in donation after circulatory death heart procurement, but its impact when the lung is also procured is unknown. The goal of this study was to examine utilization and outcomes of lung transplants in the setting of DCD heart procurement with or without NRP. We examined the United Network for Organ Sharing of all DCD heart donors from December 1, 2019 to June 23, 2022 with recorded brain death and cross clamp times, with a difference of greater than 30 minutes considered NRP procurements. Baseline characteristics, in-hospital outcomes, and one-year survival of lung transplant recipients were compared between those whose donors were managed with NRP versus no NRP. Of 447 DCD heart procurements with adequate data, 157(35%) were conducted with NRP. There were 62 DCD lung transplant recipients where the heart was also procured, of which 22(35%) came from NRP-managed donors and 40 (65%) from non-NRP managed donors. Lung utilization rates were not significantly different between NRP and non-NRP managed DCD heart donors (14% vs 14%, p=0.95). Donors in the NRP group were more frequently male (100% vs 70%, p<0.01) while recipients had significantly lower lung allocation scores [37 (34-41) vs 40 (36-57), p=0.02]. There were no other differences in other baseline characteristics, including EVLP use(18% vs 14%, p=0.73). Rates of ECMO (14% vs 15%, p=0.92), grade 3 PGD (18% vs 23%, p=0.70), intubation (36% vs 48%, p=0.40), and inhaled nitric use (14% vs 15%, p=0.88) 72 hours post-transplant were not significantly different. One-year survival was comparable between the two groups (86% vs 86%, p=0.94). A small number of DCD lung transplants are performed when the heart was also procured, with approximately one-third of these donors managed with NRP. While sample size was limited, NRP did not have a detrimental impact on short-term outcomes or one-year survival in lung transplant recipients. [ABSTRACT FROM AUTHOR]