Impact of normothermic regional perfusion on ex vivo lung perfusion outcomes in donation after circulatory death lung donors

Caitlin T Demarest; Brandi Z Zofkie; Sam Popa; John W Stokes; Riley Messer; Kirby von Kessler; Anil J Trindade; Stefan Schwarz; Andrew Sage; Elly Zhou; Sumin Kim; Micheal C McInnis; Shaf Keshavjee; Jorge Mallea; Matthew Bacchetta; Konrad Hoetzenecker

doi:10.1016/j.jtcvs.2025.10.014

Impact of normothermic regional perfusion on ex vivo lung perfusion outcomes in donation after circulatory death lung donors

J Thorac Cardiovasc Surg. 2025 Oct 16:S0022-5223(25)00879-7. doi: 10.1016/j.jtcvs.2025.10.014. Online ahead of print.

Authors

Affiliations

¹ Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
² Lung Bioengineering Inc, Silver Spring, Md; Lung Bioengineering Inc, Jacksonville, Fla.
³ Lung Bioengineering Inc, Silver Spring, Md.
⁴ Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
⁵ Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
⁶ Toronto General Hospital Research Institute, University Health Network, Latner Thoracic Research Laboratories, Toronto, Ontario, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Fla.
⁹ Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tenn.
¹⁰ Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn. Electronic address: konrad.hoetzenecker@vumc.org.

PMID: 41109633
DOI: 10.1016/j.jtcvs.2025.10.014

Abstract

Objectives: Ex vivo lung perfusion (EVLP) is commonly used to assess extended-criteria donor lungs, particularly from donation after circulatory death (DCD) donors. Normothermic regional perfusion (NRP) is increasingly used in DCD procurement, but its impact on EVLP outcomes remains unclear.

Methods: This study included 187 DCD lungs perfused between October 2021 and August 2024 at 2 centralized EVLP facilities. Donor demographics, EVLP characteristics, and radiographs obtained during EVLP were analyzed.

Results: In total, 160 lungs were assessed by EVLP after rapid procurement; 13 of these were procured in the setting of an abdominal NRP protocol. In total, 23 DCD donor lungs underwent EVLP after thoracoabdominal (TA) NRP procurement. The primary indication for EVLP across the whole study cohort was DCD status (41%), followed by concerns about organ quality raised by the procurement team (34%), and low oxygen tension (12%). One lung from the TA-NRP group and 3 lungs from the rapid procurement group were not placed on EVLP upon arrival at the EVLP facility because of grossly abnormal appearance. Decline rates were 52% in the TA-NRP group and 50% in the rapid procurement group (P = .777). EVLP characteristics as well as radiographs were comparable across the 2 groups. In multivariate analysis, none of the available donor demographic factors or the indications for EVLP influenced EVLP outcomes. Notably, also TA-NRP was not a significant factor for EVLP conversion rates in multivariate analysis (odds ratio, 0.889; 0.338-2.339; P = .812).

Conclusions: This early experience suggests that EVLP can be safely performed after TA-NRP without increasing the risk of donor lung loss.

Keywords: donation after circulatory death; ex vivo lung perfusion; lung transplantation; normothermic regional perfusion.