Two hundred cases of cardiac donation after circulatory death utilizing normothermic regional perfusion: The 4-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 retrospectively reviewed from October 2020 to November 2024. Donor and recipient pairs were divided into four 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 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 the evolution of the NRP recovery process has afforded continued excellent recipient outcomes that can be translatable to other centers.