Donation after circulatory death with thoracoabdominal normothermic regional perfusion recovery has similar outcomes with donation after brain death for lung transplantation

Introduction Donation after circulatory death (DCD) with thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly used to procure cardiac allografts; however, concerns persist regarding its impact on lung allografts. We present our institution's experience with DCD TA-NRP and donation after brain death (DBD) lung transplants, comparing outcomes between the two techniques. Methods All lung transplants recovered with DBD or DCD TA-NRP performed between October 2022-December 2024 were included. DCD TA-NRP procured lungs were retrieved using a lung protective strategy including early reintubation and pulmonary venting as previously described. The primary outcome was survival with secondary outcomes of primary graft dysfunction (PGD) and pulmonary-related mortality. Results There were 85 DBD and 23 DCD TA-NRP lung transplants performed in the study period. Overall survival was not significantly different by Kaplan-Meier curve (p=0.49) with 1-year absolute survival of 81.6% for DCD TA-NRP, with only 1 pulmonary-related mortality, and 89.4% for DBD, with 6 pulmonary-related mortalities. PGD grade 3 rates were not statistically different at postoperative day (POD) 0 (47.8% DCD TA-NRP vs 35.2% DBD, p=0.27), POD 1 (21.7% vs 10.6%, p=0.16), POD2 (8.7% vs 11.7%, p=0.68), and POD3 (13.0% vs 11.8%, p=0.87). Other intraoperative and postoperative outcomes were not significantly different. Conclusion Lung transplantation outcomes were not significantly different between lung grafts recovered by DCD TA-NRP and DBD. This early data suggests TA-NRP may not adversely impact DCD lung allografts during procurement.