Minasyan Anna, de la Torre Mercedes, Rosado Rodriguez Joel, Jauregui Abularach Alberto, Romero Román Alejandra, Novoa Valentin Nuria, Martínez Serna Ivan, Gámez García Pablo, Fontana Alilis, Sales Badia Gabriel, González García Francisco Javier, Salvatierra Velazquez Angel, Berjon Loreto, Mons Lera Roberto, Rodríguez Suarez Pedro, Coll Elisabeth, Miñambres Eduardo, Domínguez-Gil Beatriz, Campo-Cañaveral de la Cruz Jose Luis
Department of Thoracic Surgery, Coruña University Hospital, La Coruña, Spain.
Department of Thoracic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
J Heart Lung Transplant. 2025 May;44(5):697-705. doi: 10.1016/j.healun.2024.09.018. Epub 2024 Sep 30.
Thoraco-abdominal normothermic regional perfusion (TA-NRP) has emerged as a strategy for evaluating and recovering the heart in controlled donation after the circulatory determination of death (cDCDD). However, its impact on lung grafts remains largely unknown. We aimed to assess the impact of TA-NRP on the outcomes of recipients of cDCDD lungs.
This is a retrospective, multicenter, nationwide study describing the outcomes of cDCDD lung transplants (LTs) performed in Spain from January 2021 to November 2023. Patients were divided in 2 groups based on the recovery technique: TA-NRP with the simultaneous recovery of the heart vs abdominal NRP (A-NRP) without simultaneous heart recovery. The primary endpoint was the incidence of Primary Graft Dysfunction (PGD) grade 3 at 72 hours. Secondary endpoints included the overall incidence of PGD, days on mechanical ventilation, intensive care unit (ICU) and hospital length of stay, early survival rates, and mid-term outcomes.
Two hundred and eighty three cDCDD LTs were performed during the study period, 28 (10%) using TA-NRP and 255 (90%) using A-NRP. No differences were observed in the incidence of PGD grade 3 at 72 hours between the TA-NRP and the A-NRP group (0% vs 7.6%; p = 0.231), though the overall incidence of PGD was significantly lower with TA-NRP (14.3% vs 41.5%; p = 0.005). We found no significant differences between the groups regarding other post-transplant outcome variables.
TA-NRP allows the simultaneous recovery of both the heart and the lungs in the cDCDD scenario with appropriate LT outcomes comparable to those observed with the A-NRP approach.
胸腹常温区域灌注（TA-NRP）已成为在循环判定死亡后进行可控捐赠时评估和恢复心脏功能的一种策略。然而，其对肺移植的影响在很大程度上仍不清楚。我们旨在评估TA-NRP对循环判定死亡供肺受者结局的影响。
这是一项回顾性、多中心、全国性研究，描述了2021年1月至2023年11月在西班牙进行的循环判定死亡供肺移植（LT）的结局。根据恢复技术将患者分为两组：同时恢复心脏的TA-NRP组与不同时恢复心脏的腹部NRP（A-NRP）组。主要终点是72小时时3级原发性移植物功能障碍（PGD）的发生率。次要终点包括PGD的总体发生率、机械通气天数（MV）、重症监护病房（ICU）和住院时间、早期生存率以及中期结局。
研究期间共进行了283例循环判定死亡供肺移植，其中28例（10%）采用TA-NRP，255例（90%）采用A-NRP。TA-NRP组和A-NRP组在72小时时3级PGD的发生率上没有差异（0%对7.6%；p = 0.231），尽管TA-NRP组PGD的总体发生率显著更低（14.3%对41.5%；p = 0.005）。在其他移植后结局变量方面，两组之间没有显著差异。
在循环判定死亡供肺移植中，TA-NRP能够同时恢复心脏和肺功能，其LT结局与A-NRP方法相当。
