Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation

Yuki Bekki; Kristopher P Croome; Bryan Myers; Kazunari Sasaki; Koji Tomiyama

doi:10.1097/TXD.0000000000001450

Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation

Transplant Direct. 2023 Feb 17;9(3):e1450. doi: 10.1097/TXD.0000000000001450. eCollection 2023 Mar.

Authors

Yuki Bekki¹, Kristopher P Croome², Bryan Myers¹, Kazunari Sasaki³, Koji Tomiyama⁴

Affiliations

¹ Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, NY.
² Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
³ Division of Abdominal Transplant, Department of General Surgery, Stanford University Medical Center, Stanford, CA.
⁴ Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.

Abstract

Normothermic regional perfusion (NRP) has gained widespread adoption in multiple European countries. The aim of this study was to examine the influence of thoracoabdominal-NRP (TA-NRP) on the utilization and outcomes of liver, kidney, and pancreas transplantation in the United States.

Methods: Using the US national registry data between 2020 and 2021, donation after circulatory death (DCD) donors were separated into 2 groups: DCD with TA-NRP and without TA-NRP. There were 5234 DCD donors; among them 34 donors were with TA-NRP. After 1:4 propensity score matching, the utilization rates were compared between DCD with and without TA-NRP.

Results: Although the utilization rates of kidney and pancreas were comparable (P = 0.71 and P = 0.06, 94.1% versus 95.6% and 8.8% versus 2.2%, respectively), that of liver in DCD with TA-NRP was significantly higher (P < 0.001; 70.6% versus 39.0%). Among 24 liver transplantations, 62 kidney transplantations, and 3 pancreas transplantations from DCD with TA-NRP, there were 2 liver grafts and 1 kidney graft that failed within 1 y after transplantation.

Conclusions: TA-NRP in the United States significantly increased the utilization rate of abdominal organs from DCD donors with comparable outcomes after transplantation. Increasing use of NRP may expand the donor pool without compromising transplant outcomes.