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Outcomes of Simultaneous Heart-Kidney Transplantation Using Donor Hearts After Circulatory Death: Normothermic Regional Perfusion vs Direct Procurement and Perfusion
Abstract   Peer reviewed

Outcomes of Simultaneous Heart-Kidney Transplantation Using Donor Hearts After Circulatory Death: Normothermic Regional Perfusion vs Direct Procurement and Perfusion

H. Zappacosta, P. Cho, A. Girish, J. White, S. McKay, J. Song and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 325-326
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.698

Abstract

Purpose: Normothermic regional perfusion (NRP) is a novel and expanding method for procurement of hearts in donation after circulatory death (DCD), an alternative to the traditional direct procurement and perfusion (DPP) method. This study aims to compare outcomes of simultaneous heart-kidney transplantation using DCD donor hearts procured using NRP versus DPP. Methods: The United Network for Organ Sharing database was queried for all adult simultaneous heart-kidney transplants using DCD donor hearts from January 2020 to June 2025. Donors were stratified by procurement method based on the time between circulatory death and cross-clamp, with less than or equal to 30 minutes defined as DPP and greater than 30 minutes defined as NRP. Outcomes of interest included severe PGD, need for renal replacement therapy, 30-day mortality, and 6-month survival. Results: Of 175 DCD heart-kidney transplantations during the study period, 68 (38.8%) were procured using NRP. NRP recipients were less likely to have a left ventricular assist device prior to transplant (7.4% vs 22.4%; p=0.009). Perioperative outcomes were similar between NRP and DPP groups, including incidence of severe PGD (2.9% vs 1.9%; p=0.64), acute rejection (4.4% vs 7.5%; p=0.42), 30 day mortality (1.5% vs 4.7%; p=0.26), and in-hospital mortality (3.1% vs 5.9%; p=0.42). There was no significant difference in requirement of dialysis during the index hospitalization (30.9% vs 43.0%; p=0.11) or need for renal replacement therapy at any point during follow-up (1.5% vs 3.7%; p=0.38). Kaplan Meier survival analysis showed no difference in 6-month survival between groups (Figure). Conclusion: Both NRP and DPP prove reliable in donor heart procurement after circulatory death when simultaneously transplanted with a kidney. There are no differences in perioperative outcomes between procurement methods, suggesting continued expansion of use of both techniques.

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