Improved Organ Utilization and Better Transplant Outcomes with in Situ Normothermic Regional Perfusion in Controlled Donation after Circulatory Death

Abstract

Background. We evaluated whether the use of normothermic regional perfusion (NRP) was associated with increased organ recovery and improved transplant outcomes from controlled donation after circulatory death (cDCD). Methods. This is a retrospective analysis of UK adult cDCD donors‚ where at least 1 abdominal organ was accepted for transplantation between January 1, 2011, and December 31, 2019. Results. A mean of 3.3 organs was transplanted when NRP was used compared with 2.6 organs per donor when NRP was not used. When adjusting for organ-specific donor risk profiles, the use of NRP increased the odds of all abdominal organs being transplanted by 3-fold for liver (P < 0.0001; 95% confidence interval [CI], 2.20-4.29), 1.5-fold for kidney (P = 0.12; 95% CI, 0.87-2.58), and 1.6-fold for pancreas (P = 0.0611; 95% CI, 0.98-2.64). Twelve-mo liver transplant survival was superior for recipients of a cDCD NRP graft with a 51% lower risk-adjusted hazard of transplant failure (HR = 0.494). In risk-adjusted analyses, NRP kidneys had a 35% lower chance of developing delayed graft function than non-NRP kidneys (odds ratio, 0.65; 95% CI, 0.465-0.901)‚ and the expected 12-mo estimated glomerular filtration rate was 6.3 mL/min/1.73 m2 better if abdominal NRP was used (P < 0.0001). Conclusions. The use of NRP during DCD organ recovery leads to increased organ utilization and improved transplant outcomes compared with conventional organ recovery.