Rise of the machines: Normothermic regional perfusion use in heart transplantation in the United States.

Normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) allow for transplantation with donation after circulatory death (DCD) hearts. This study aimed to characterize the use of and variations in NRP and DPP for DCD transplants in the United States. Heart transplants performed between December 1, 2019 and March 31, 2024, were identified from the United Network for Organ Sharing database. DPP and NRP procurement strategies were classified based on previously published methods. The groups were compared, and survival was assessed using Kaplan-Meier methods. Geographic and center variability was categorized using encrypted data. There were 595 NRP transplants and 625 DPP transplants. Distance traveled and out-of-body time were significantly lower for the NRP group (P < .01 for both). There were no significant differences in postoperative dialysis, stroke, or 1-year survival between the 2 groups; however, the rate of postoperative pacemaker placement was higher with NRP (P < .05). From 2019 to 2024, 54 of 61 centers (88.5%) used NRP, 50 of 61 centers (82%) used DPP, and 43 of 61 centers (70.5%) used both procurement techniques, with NRP the more popular DCD procurement technique. Geographically, NRP was more prevalent in regions 2, 5, and 8 used, whereas DPP was most prevalent in regions 1, 3, and 10. The use of NRP is increasing in the United States, with tremendous growth seen since its introduction several years ago. Significant variation remains in the use of NRP and DPP, and further exploration of the impact of each procurement and preservation strategy on transplantation outcomes is needed.

Gouchoe DA ，Satija D ，Cui EY ，Schroder JN ，Milano CA ，Bishawi M ，Alvarez AV ，Choi K ，Henn MC ，Lampert BC ，Mokadam NA ，Whitson BA ，Ganapathi AM ... -  《-》

Direct procurement with machine perfusion and normothermic regional perfusion in donation after circulatory death heart transplantation.

Donation after circulatory death (DCD) heart transplants have increased in the United States with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of the DCD technique on post-transplant outcomes compared to donation after brain death (DBD) donors. Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023, were identified in the United Network for Organ Sharing registry. DPP and TA-NRP groups were identified using time of death to an aortic cross-clamp time of 30 minutes. Categorical variables were compared using the χ2 or Fisher exact test, and continuous variables were compared using the Mann-Whitney U test. Propensity score matching was performed using a 1:3 match. One-year survival was analyzed using the log-rank test and a Cox proportional hazard regression model. During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1 year post-transplant, there was no difference in survival between unmatched (P = .13) and matched (P = .36) DBD and DCD heart recipients. There was an increase in acute rejection and rejection requiring treatment in DCD recipients compared to DBD recipients in the matched cohort. A total of 134 TA-NRP transplants and 242 DPP transplants were performed. One-year survival and post-transplant outcomes were similar in the DPP and TA-NRP groups. TA-NRP functional warm ischemia time (fWIT) was increased significantly during the study period. In this matched cohort, DCD heart recipients experienced increased acute rejection, both treated and nontreated, compared to DBD heart recipients. Despite differences in the techniques and likely in fWIT, acute rejection, survival, and other secondary outcomes are similar with DPP and TA-NRP.

Goodwin ML ，Nickel IC ，Li H ，Kagawa H ，Kyriakopoulos CP ，Hanff TC ，Stehlik J ，Drakos SG ，Selzman CH ... -  《-》

Early U.S. Heart Transplant Experience With Normothermic Regional Perfusion Following Donation After Circulatory Death.

Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S. experience with the normothermic regional perfusion (NRP) DCD HT procurement method has not been evaluated. The aim of this study was to examine short-term outcomes associated with NRP vs direct procurement and perfusion (DPP) methods used during DCD HT in the United States. The UNOS (United Network for Organ Sharing) registry was queried for all adult (age ≥18 years) heart recipients and corresponding donors of controlled DCD HT from January 2019-December 2023. Transplantations were stratified by NRP or DPP reperfusion methods. The primary outcome was overall survival. A total of 918 heart donors and recipients met inclusion criteria, including 622 (68%) DPP and 296 (32%) NRP transplantations. Unadjusted Kaplan-Meier survival analysis demonstrated improved short-term survival associated with NRP (log-rank P = 0.005). After adjustment, DCD HT with NRP was independently associated with improved survival (HR: 0.39 [95% CI: 0.22-0.70]; P = 0.002). A propensity-matched analysis similarly demonstrated a cumulative survival benefit to NRP (log-rank P = 0.006). In this largest national series of DCD HT procurement perfusion strategies, NRP is associated with improved short-term survival as compared with DPP. This study evaluates the U.S. early experience with DCD HT, and longer-term follow-up data are needed to further assess the impact of DPP and NRP methods on post-heart transplantation outcomes.

Benkert AR ，Keenan JE ，Schroder JN ，DeVore AD ，Patel CB ，Milano C ，Jawitz OK ... -  《-》

Normothermic Regional Perfusion Experience of Organ Procurement Organizations in the US.

Sellers MT ，Philip JL ，Brubaker AL ，Cauwels RL ，Croome KP ，Hoffman JR ，Neidlinger NA ，Reynolds AM ，Wall AE ，Edwards JM ... -  《JAMA Network Open》

Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021.

Gentzke AS ，Wang TW ，Cornelius M ，Park-Lee E ，Ren C ，Sawdey MD ，Cullen KA ，Loretan C ，Jamal A ，Homa DM ... -  《MMWR SURVEILLANCE SUMMARIES》