Williams Jonathan E, Trahanas John M, Klapper Jacob A, Demarest Caitlin, Lagisetty Kiran H, Chang Andrew C, Lyu Dennis M, Odell David D, Bacchetta Matthew D, Williams Aaron M
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Clin Transplant. 2025 Mar;39(3):e70135. doi: 10.1111/ctr.70135.
Use of normothermic regional perfusion (NRP) to recover donation after circulatory death (DCD) organs demonstrates increased heart utilization with favorable outcomes. Conversely, DCD lung allograft use when NRP was employed remains controversial. This is a contemporary analysis of DCD lung recipient outcomes in which NRP was used.
Utilizing the STAR-OPTN database, all adult DCD lung recipients in the United States between January 1, 2020, and June 30, 2024 were identified. NRP use was defined if the time between donor death and aortic clamp time was greater than 30 min. Recipient outcomes, including 30-, 60-, and 90-day mortality, grade-3 primary graft dysfunction (PGD), and postoperative length of stay were compared using multivariable logistic regression controlling for donor and recipient covariates. Survival analysis was performed using Cox proportional hazard modeling.
Of 987 DCD lung transplants, 92 (9.4%) utilized NRP. There were no differences in recipient characteristics between direct recovery and NRP cohorts. No difference in 30-, 60-, or 90-day mortality, grade-3 PGD, or length of stay was found between cohorts. 12-month survival was equivalent.
Outcomes between NRP lung recipients were equivalent to DCD direct recovery recipients. Thus, donor lungs may be considered for transplantation following NRP donation procedures.
使用常温区域灌注（NRP）来恢复心脏死亡后捐赠（DCD）器官的功能，已证明心脏利用率有所提高且预后良好。相反，在采用NRP时，DCD肺移植的使用仍存在争议。这是一项对采用NRP的DCD肺移植受者预后的当代分析。
利用器官获取与移植网络（OPTN）数据库，确定了2020年1月1日至2024年6月30日期间在美国接受DCD肺移植的所有成年受者。如果供者死亡至主动脉钳夹时间大于30分钟，则定义为使用了NRP。使用多变量逻辑回归分析比较受者的预后，包括30天、60天和90天死亡率、3级原发性移植功能障碍（PGD）和术后住院时间，并对供者和受者的协变量进行控制。使用Cox比例风险模型进行生存分析。
在987例DCD肺移植中，92例（9.4%）使用了NRP。直接恢复组和NRP组的受者特征无差异。两组在30天、60天或90天死亡率、3级PGD或住院时间方面均无差异。12个月生存率相当。
NRP肺移植受者的预后与DCD直接恢复受者相当。因此，在NRP捐赠程序后，供肺可考虑用于移植。
