200 Cases of Cardiac Donation after Circulatory Death Utilizing Normothermic Regional Perfusion: The Four-Year Vanderbilt Experience.

Objectives: Studies evaluating normothermic regional perfusion (NRP) for donation after circulatory death (DCD) heart recovery involve low volume centers or multi-center studies with wide variation in practice/technique. We sought to provide a single high-volume center's experience encompassing our program's evolution of NRP over time.

Methods: Adult DCD heart transplant patients who received cardiac allografts recovered using only thoracoabdominal NRP were retrospective reviewed from October 2020 to November 2024. Donor and recipient pairs were divided into 4 groups (or Eras) based on year of transplant and compared. Hazard and confidence scores were compared highlighting changes in postoperative outcomes, and donor aggressiveness and high-risk recipients, respectively. NRP recovery details were compared.

Results: Heart recovery attempts were made on 200 donors with 176 accepted for transplant (88%). Recipient postoperative outcomes demonstrated no significant difference across Eras. Functional warm ischemic time (FWIT) increased (p< 0.05) over the Eras. Cold ischemic time (CIT) also increased from Era 1 to Era 4 (p < 0.05). Allograft turn-downs due to technical reasons trended downwards from Era 1 (4/35, 11.5%) to Era 4 (1/62, 1.6%) (p = 0.16). The hazard score reflecting recipient outcomes was comparable across all four eras (p = 0.84), while the confidence score reflecting donor aggressiveness and high-risk recipients significantly increased (p < 0.05).

Conclusions: Despite adopting a more aggressive approach with donor selection and high-risk recipients over time, technical improvements and evolution of the NRP recovery process has afforded continued excellent recipient outcomes that can be translatable to other centers.