Abstract
Background
Thoracoabdominal normothermic regional perfusion (TA‐NRP) and hypothermic machine perfusion (HMP) reduce ischemia–reperfusion injury after donation after circulatory death (DCD) kidney transplantation, but their combined effects remain unclear.
Methods
Adult DCD kidney‐only recipients undergoing pretransplant dialysis in the OPTN registry (2020–2025) were stratified by TA‐NRP and HMP. The primary outcome was delayed graft function (DGF). Multivariable logistic regression included a TA‐NRP × HMP interaction and adjusted for recipient and donor factors. Death‐censored graft survival (DCGS) was evaluated by Kaplan–Meier analysis.
Results
Among 3502 recipients, DGF differed by preservation strategy. In the non‐TA‐NRP cohort, HMP significantly reduced DGF compared with static cold storage (SCS) (44.2% vs 53.8%;
p
= 0.001) and remained independently protective (adjusted OR 0.56; 95% CI 0.44–0.71;
p
p
= 0.98), with no independent association after adjustment (adjusted OR 0.82; 95% CI 0.62–1.08;
p
= 0.16). A significant TA‐NRP × HMP interaction was observed (
p
= 0.039). In the absence of HMP, TA‐NRP was strongly protective against DGF (adjusted OR 0.30; 95% CI 0.22–0.42;
p
p
= 0.73).
Conclusion
TA‐NRP was associated with lower DGF than conventional DCD procurement. Within the TA‐NRP cohort, HMP was not associated with additional reductions in DGF. These findings should be interpreted in light of the surrogate definition used to identify TA‐NRP in the OPTN registry and warrant prospective validation.