To Reanimate or Not: Rapid Recovery Versus Thoraco-abdominal Normothermic Regional Perfusion in Donation after Circulatory Death Heart Transplantation.

OBJECTIVES: Rapid recovery with extended ultraoxygenated preservation (REUP) is a novel method of recovering donation after circulatory death (DCD) hearts that obviates the need for donor heart reanimation, a distinct difference to direct procurement and perfusion or thoracoabdominal normothermic regional perfusion (TA-NRP). This study compares the impact of REUP and TA-NRP on early DCD heart transplantation outcomes. METHODS: All DCD heart transplants from a single institution between 07/2023-10/2025 recovered using TA-NRP and REUP and preserved at 10°C static storage were included. Propensity-score matching created balanced cohorts. Primary outcomes included severe primary graft dysfunction (PGD), clinical outcomes during index hospitalization, rejection, and mortality. RESULTS: 147 DCD heart transplants met inclusion criteria, of which 107 (72.8%) were recovered with TA-NRP and 40 (27.2%) with REUP. Donor and recipient characteristics were comparable between the groups. Total ischemic time was longer in the REUP group (median 263 min vs 229, p<0.001). Propensity score matching created balanced cohorts (40 NRP and 40 REUP). Among matched cohorts, rates of severe PGD (7.5% REUP vs 15.0% NRP, p=0.51), 90-day mortality (5.0% REUP vs 17.5% NRP, p=0.079), and acute cellular rejection grade ≥2R (20.0% REUP vs 27.5% NRP, p=0.61) were comparable. All other clinical outcomes were also similar between the matched cohorts. CONCLUSIONS: Early data suggests that REUP may be a safe alternative to TA-NRP in DCD heart recovery. This calls into question whether donor heart reanimation is truly needed to successfully recover DCD hearts.