Outcomes of donation after circulatory death heart transplant using normothermic regional perfusion: a systematic review and meta-analysis.

Abstract

This systematic review and meta-analysis aim to synthesize evidence comparing normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) in donation after circulatory death (DCD) heart transplantation, providing evidence-based guidance for optimizing donor heart procurement and transplantation protocols. A systematic literature review was conducted following PRISMA guidelines. PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform were systematically searched. Two reviewers independently applied eligibility criteria, evaluated quality, and extracted data. The primary outcome was the 30-day survival rate. The 30-day survival rates for NRP and DPP patients were 96.58% and 94.79%, respectively (odds ratio [OR]: 1.52, 95% confidence interval [CI] 1.06-2.17, P = 0.02). Severe primary graft dysfunction (PGD) rates for NRP and DPP patients were 7.90% and 14.03%, respectively (P = 0.002), while the combined rate of none/mild PGD was 86.36% and 85.84% for each group. The cumulative postoperative extracorporeal membrane oxygenation rate for NRP patients was 6.54%, compared to 17.18% for DPP patients (P = 0.0001). The postoperative intra-aortic balloon pump rate for NRP patients was 9.09%, compared to 17.78% for DPP patients (P = 0.35). NRP patients had a higher likelihood of being discharged home than DPP patients (P = 0.36), while NRP patients had a lower likelihood of being discharged from the intensive care unit than DPP patients (P = 0.71). NRP was associated with higher 30-day survival, which is a promising clinical approach in the application of DCD donor hearts.