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 and 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 ( = 0.49), with 1-year absolute survival of 81.6% for DCD TA-NRP, with only one pulmonary-related mortality, and 89.4% for DBD, with six 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,  = 0.27), POD 1 (21.7% vs 10.6%,  = 0.16), POD2 (8.7% vs 11.7%,  = 0.68), and POD3 (13.0% vs 11.8%,  = 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.