To Reanimate or Not: Rapid Recovery Versus Thoraco-abdominal Normothermic Regional Perfusion in Donation after Circulatory Death Heart Transplantation.

Abstract

Rapid recovery with extended ultraoxygenated preservation (REUP) is a novel method of recovering donation after circulatory death (DCD) hearts that obviates the need for donor heart reanimation, a distinct difference to direct procurement and perfusion or thoracoabdominal normothermic regional perfusion (TA-NRP). This study compares the impact of REUP and TA-NRP on early DCD heart transplantation outcomes. All DCD heart transplants from a single institution between 07/2023-10/2025 recovered using TA-NRP and REUP and preserved at 10°C static storage were included. Propensity-score matching created balanced cohorts. Primary outcomes included severe primary graft dysfunction (PGD), clinical outcomes during index hospitalization, rejection, and mortality. 147 DCD heart transplants met inclusion criteria, of which 107 (72.8%) were recovered with TA-NRP and 40 (27.2%) with REUP. Donor and recipient characteristics were comparable between the groups. Total ischemic time was longer in the REUP group (median 263 min vs 229, p<0.001). Propensity score matching created balanced cohorts (40 NRP and 40 REUP). Among matched cohorts, rates of severe PGD (7.5% REUP vs 15.0% NRP, p=0.51), 90-day mortality (5.0% REUP vs 17.5% NRP, p=0.079), and acute cellular rejection grade ≥2R (20.0% REUP vs 27.5% NRP, p=0.61) were comparable. All other clinical outcomes were also similar between the matched cohorts. Early data suggests that REUP may be a safe alternative to TA-NRP in DCD heart recovery. This calls into question whether donor heart reanimation is truly needed to successfully recover DCD hearts.