Outcomes of lung and heart-lung transplants utilizing donor after circulatory death with thoracoabdominal normothermic regional perfusion
Stephanie H. Chang, MD,
Travis C. Geraci, MD,
Greta L. Piper, MD,
Justin Chan, MD,
Les James, MD,
Darien Paone, MD,
Philip M. Sommer,
Jake Natalini, MD,
Darya Rudym, MD,
Melissa Lesko, MD,
Syed T. Hussain, MD,
Alex Reyentovich, MD,
Nader Moazami, MD,
Deane E. Smith, MD,
Luis Angel, MD
Affiliations
Stephanie H. Chang, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York; Corresponding author: Stephanie H. Chang, MD, New York University Langone Health, Department of Cardiothoracic Surgery, 530 First Avenue, Suite 9V, New York, NY 10016.
Travis C. Geraci, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Greta L. Piper, MD
Department of Cardiothoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York
Justin Chan, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Les James, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Darien Paone, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Philip M. Sommer
Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, New York
Jake Natalini, MD
Department of Medicine, NYU Langone Health, New York, New York
Darya Rudym, MD
Department of Medicine, NYU Langone Health, New York, New York
Melissa Lesko, MD
Department of Medicine, NYU Langone Health, New York, New York
Syed T. Hussain, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Alex Reyentovich, MD
Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
Nader Moazami, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Deane E. Smith, MD
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
Luis Angel, MD
Department of Medicine, NYU Langone Health, New York, New York
Background: Donation after circulatory death with thoracoabdominal normothermic regional perfusion (DCD-NRP) for cardiac transplant has promising results, though data for lung transplant is lacking. This study evaluates lung transplant outcomes using DCD-NRP allografts. Methods: All patients who underwent lung transplantation (LT) from June 1, 2020, to July 5, 2023, at a single institution were evaluated. Recipients received organs from DCD-NRP or brain dead (control) donors (donation after brain death (DBD)). All DCD-NRP were adult, primary bilateral LT (BLT) without preoperative extracorporeal membrane oxygenation (ECMO). Inclusion criteria for controls were age >18 years, BLT, no preoperative ECMO, and primary transplantation. Comparison was separated by LT or heart-lung transplant (HLT). The primary outcome was primary graft dysfunction (PGD) grade 3 at 72 hours. Results: There were 8 LT and 3 HLT in the DCD-NRP cohort, and 138 BLT and 7 HL DBD controls. PGD grade 3 at 72 hours was 0% in the entire DCD-NRP cohort (vs control: 9.4% LT and 0% HLT). There were no statistically significant differences in donor and recipient characteristics, though DCD-NRP HLT had significantly shorter ischemic time (85 vs 200 minutes, p < 0.02). Thirty-day and 90-day mortality and 1-year survival are similar in both cohorts for LT and HLT. To date, DCD-NRP recipients are all on room air, with 0% acute cellular rejection rate and 91% (10/11) without chronic rejection. The lung utilization rate of evaluated DCD-NRP donors was 100%. Conclusions: Initial results of LT using DCD-NRP organs demonstrate similar PGD grade 3 at 72 hours and similar survival to standard donors.
