Impact of NRP on outcomes following DCD kidney transplantation: A US nationwide analysis

Results from a US nationwide registry analysis, evaluating the impact of normothermic regional perfusion (NRP) on outcomes following donation after circulatory death (DCD) kidney transplantation, were published in Annals of Surgery by Kusakabe et al. Data were analyzed using propensity score matching (PSM) to balance donor and recipient characteristics (NRP, n = 2,131; non-NRP, n = 10,598). NRP was classified as 30–180 minutes from circulatory death to cross-clamp. The primary endpoint was overall graft survival. 

Key data: After PSM, NRP was associated with lower graft loss compared with non-NRP procurement at 1 year (6.5% vs 8.2%; p = 0.042) and 3 years (12.1% vs 18.0%; p = 0.005). Patient mortality at 3 years post-transplant was lower in the NRP group (7.4% vs 12.5%; p = 0.031); 1-year mortality was similar between groups (4% vs 4.8%; p = 0.48). The incidence of delayed graft function (DGF) was lower with NRP compared with non-NRP (30.3% vs 49.7%; risk ratio [RR], 0.61; 95% confidence interval [CI], 0.57–0.65; p < 0.001). In subgroup analyses, the 1-year graft survival benefit with NRP was most pronounced among higher-risk subgroups, including transplants involving older donors and recipients.

Key learning: NRP was associated with improved graft survival and reduced DGF compared with non-NRP procurement in DCD kidney transplantation, with pronounced benefits observed among higher-risk subgroups.