Donation after circulatory determination of death (DCD) heart transplant recipients with hearts retrieved via thoraco-abdominal normothermic regional perfusion (taNRP) were less likely to have severe primary graft dysfunction (PGD) and exhibited fewer episodes of biopsy-proven acute-cellular rejection (ACR) at one year compared to those with hearts retrieved through direct procurement and perfusion (DPP), according to an international, multicenter study presented at ISHLT 2025 and simultaneously published in JACC: Heart Failure.

In their retrospective, observational study investigating DCD heart transplantation in both Europe and the U.S., John O. Louca, MB, BChir, et al., included 504 DCD heart transplant patients from 20 centers. At one year follow-up, the authors analyzed post-transplant outcomes including survival, severe PGD and episodes of treated, biopsy-proven ACR, comparing cases with donor hearts retrieved via taNRP vs. DPP.

Although survival rates at one year post transplantation were similar for the two groups, taNRP recipients were less likely to experience severe PGD (7.6% vs. 19.2%, p<0.001). Additionally, fewer incidences of biopsy-proven ACR were observed in the taNRP group (13% vs. 25%, p<0.001).

The authors suggest that "taNRP exerts a protective effect on the endothelium. It may be that the longer [function total ischemic time] in DPP, or alternatively the inflammatory milieu the heart is exposed to during machine perfusion results in greater endothelial damage with greater exposure of donor antigens to the recipient immune system."

They also acknowledge several study limitations, including its observational nature, missing data and differences in the way centers measure certain study variables. According to the authors, a randomized control trial "is needed to definitively compare these two methods of DCD heart procurement."