The United Kingdom's experience of controlled donation after circulatory death direct procurement of lungs with concomitant abdominal normothermic regional perfusion with an analysis of short-term outcomes
Williams, Luke John Lloyd Hogg, Rachel Roque, Miguel Angel Reyes Beale, Sarah Husain, Mubassher Jothidasan, Anand Zych, Bart Gerovasili, Vicky Kaul, Pradeep Tsui, Steven
Williams, Luke John Lloyd
Hogg, Rachel
Roque, Miguel Angel Reyes
Beale, Sarah
Husain, Mubassher
Jothidasan, Anand
Zych, Bart
Gerovasili, Vicky
Kaul, Pradeep
Tsui, Steven
Affiliation
NHS Blood and Transplant; Royal Papworth Hospital NHS Foundation Trust; Guy's & St Thomas' NHS Foundation Trust; Golden Jubilee University National Hospital; Manchester University NHS Foundation Trust; Newcastle Hospitals NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; The Royal Infirmary of Edinburgh; Cambridge University Hospitals NHS Foundation Trust; University Hospital Strasbourg
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Publication date
2025-04-01
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Abstract
Background: Abdominal Normothermic Regional Perfusion (A-NRP) improves outcomes for transplanted abdominal organs from Donation after Circulatory Death (DCD) donors. Concerns have been raised about the effect of A-NRP on lungs procured during multi-organ donation. We present the UK experience of performing direct procurement (DRP) of lungs from DCD donors with A-NRP.
Methods: Retrospective analysis of all 487 UK DCD lung donors between April 1, 2011 and December 31, 2023. Organ transplantation rate and 30-day, 90-day and 1-year survival rates were compared between DRP of DCD lungs, DRP of DCD lungs with A-NRP and donation after brainstem death (DBD) lungs. Primary graft dysfunction (PGD) rates were compared between DCD lungs with and without A-NRP.
Results: Three hundred ninety-seven DCD donors resulted in a lung transplant (22 retrieved by DRP with A-NRP). There was no difference in lung transplantation rates between DRP and DRP with A-NRP. Of the 390 first adult-only lung transplants performed from DCD donors, there was no significant difference in 30-day, 90-day and 1-year survival between DRP of DCD lungs and DRP with A-NRP. There was a significant difference in survival between standard DCD donors and DBD donors at 30-days and 90-days, but not 1 year. There was no significant difference in grade 3 PGD rates at 72 hours post-implantation for DCD lungs with or without A-NRP.
Conclusion: In the UK experience, use of A-NRP is not detrimental to procurement of DCD lungs. We advocate the use of this technique until further studies can explore the safety and efficacy of thoraco-abdominal NRP for lungs in multi-organ retrieval.
Citation
Williams LJL, Hogg R, Roque MAR, Beale S, Husain M, Jothidasan A, Zych B, Gerovasili V, Kaul P, Tsui S, Smail H, Adhami AA, Parmar J, Pettit S, Periasamy SA, Mohite P, Curry P, Messer S, Morcos K, Venkateswaran R, Mehta V, Dronavalli V, Ramesh BC, Ranasinghe A, Quinn D, Raj B, Sutcliffe R, Suresh D, Johnston C, Pettigrew G, Butler A, Olland A, Hardman G, Watson C, Manas D, Currie I, Berman M. The United Kingdom's experience of controlled donation after circulatory death direct procurement of lungs with concomitant abdominal normothermic regional perfusion with an analysis of short-term outcomes. J Heart Lung Transplant. 2025 Aug;44(8):1307-1318. doi: 10.1016/j.healun.2025.03.019. Epub 2025 Apr 1
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Article