Outcomes of lung and heart-lung transplants utilizing donor after circulatory death with thoracoabdominal normothermic regional perfusion

Background Donation after circulatory death with thoracoabdominal normothermic regional perfusion (DCD-NRP) for cardiac transplant has promising results, though data for lung transplant is lacking. This study evaluates lung transplant outcomes using DCD-NRP allografts. Methods All patients who underwent lung transplantation (LT) from June 1, 2020, to July 5, 2023, at a single institution were evaluated. Recipients received organs from DCD-NRP or brain dead (control) donors (donation after brain death (DBD)). All DCD-NRP were adult, primary bilateral LT (BLT) without preoperative extracorporeal membrane oxygenation (ECMO). Inclusion criteria for controls were age >18 years, BLT, no preoperative ECMO, and primary transplantation. Comparison was separated by LT or heart-lung transplant (HLT). The primary outcome was primary graft dysfunction (PGD) grade 3 at 72 hours. Results There were 8 LT and 3 HLT in the DCD-NRP cohort, and 138 BLT and 7 HL DBD controls. PGD grade 3 at 72 hours was 0% in the entire DCD-NRP cohort (vs control: 9.4% LT and 0% HLT). There were no statistically significant differences in donor and recipient characteristics, though DCD-NRP HLT had significantly shorter ischemic time (85 vs 200 minutes, p < 0.02). Thirty-day and 90-day mortality and 1-year survival are similar in both cohorts for LT and HLT. To date, DCD-NRP recipients are all on room air, with 0% acute cellular rejection rate and 91% (10/11) without chronic rejection. The lung utilization rate of evaluated DCD-NRP donors was 100%. Conclusions Initial results of LT using DCD-NRP organs demonstrate similar PGD grade 3 at 72 hours and similar survival to standard donors.