TA-NRP vs SRR in cDCD lung transplantation: An OPTN registry analysis

Results from a retrospective Organ Procurement and Transplantation Network (OPTN) registry analysis comparing outcomes with thoracoabdominal normothermic regional perfusion (TA-NRP) vs standard rapid recovery (SRR) in adults undergoing lung transplantation using grafts from controlled donation after circulatory death (cDCD) were published in the Journal of Heart and Lung Transplantation by O'Neill et al. The primary outcome was graft survival at 1 and 3 years post-transplant.

Key data: With a median follow-up of 2 years for SRR recipients (n = 1,364) and 1 year for TA-NRP recipients (n = 261), graft survival was comparable between groups (log-rank p = 0.83); 1-year rates were 87.4% vs 91.0% and 3-year rates were 69.2% vs 65.7%, respectively. After adjustment for donor age, sex, geographic region, and transplant year, TA-NRP recipients had lower odds of extracorporeal membrane oxygenation (ECMO) use at 72 hours post-transplant (adjusted odds ratio [aOR], 0.63; 95% confidence interval [CI], 0.40–0.95; p = 0.03). No differences in graft survival were observed according to ex vivo lung perfusion (EVLP) use or between TA-NRP recipients with and without concurrent heart procurement. 

Key learning: In this retrospective analysis, graft survival at 1 and 3 years was comparable between SRR and TA-NRP recipients, providing supportive evidence for the safety of TA-NRP in cDCD lung transplantation. Further longitudinal studies are warranted to establish long-term outcomes and optimal procurement protocols.