Early-to-midterm outcomes of lung transplantation following procurement with thoracoabdominal normothermic regional perfusion: An organ procurement and transplantation network analysis.

Abstract

Introduction: The use of thoracoabdominal normothermic regional perfusion (TA-NRP) for organ procurement has rapidly increased in recent years. Although excellent posttransplant outcomes have been achieved using TA-NRP in cardiac and abdominal transplantation, there are concerns that peri-procedural changes during lung procurement may lead to inferior preservation and poorer lung transplant outcomes. To guide clinical practice, we evaluated early and mid-term lung transplant outcomes after procurement using TA-NRP.

Methods: Using the UNOS/OPTN database, we conducted a retrospective analysis of lung transplants performed after controlled donation after circulatory death from 2020 through mid-2025. Recipients with lungs procured using TA-NRP were compared with recipients of lungs procured with standard rapid recovery (SRR).

Results: We identified 1333 SRR and 253 TA-NRP lung donors and 1364 SRR and 261 TA-NRP lung transplant recipients. TA-NRP donors were younger (37.9 vs 41.0 years, p<0.001) and more often male (67.2% vs 56.7%, p=0.005) than the SRR donors. TA-NRP recipients required ventilation >48 hours less often (48% vs 56%, p=0.02) and had shorter hospital stays (21 vs 24 days, p=0.02), but adjustment for donor age, sex, geographic region, and year attenuated both differences while revealing lower odds of ECMO use at 72 hours in TA-NRP recipients (aOR 0.63, p=0.03). One- and 3-year survival were comparable between TA-NRP and SRR recipients, and neither concurrent heart procurement nor use of ex vivo lung perfusion affected lung allograft outcomes.

Conclusion: Despite concerns of poorer outcomes after TA-NRP, short- and mid-term outcomes of lung transplant support the safety of this procurement technique.