LUNG TRANSPLANTATION AFTER PROLONGED TA-NRP IN COMBINED HEART-LUNG PROCUREMENT FROM CONTROLLED DCD DONORS IN ITALY

: Thoraco-abdominal normothermic regional perfusion(TA-NRP) is an emerging strategy for heart recovery in controlled donation after circulatory death(cDCD). Its impact on lung graft retrieval remains debated, especially regarding the duration of TA-NRP. This is particularly relevant in Italy, where the world's longest mandatory stand-off period(20 minutes) leads to prolonged TA-NRP for heart assessment. This study evaluates the impact of TA-NRP on lung transplant(LT) outcomes in a nationwide experience. We analyzed all cDCD donations between June 2023 and June 2025 where both heart and lungs were considered for retrieval. TA-NRP was established through femoral vessels, with left atrial or pulmonary artery venting. During the study period, 24 cDCD donors were evaluated for combined heart-lung procurement. Sixteen lungs were successfully retrieved and bilaterally transplanted into recipients (median age: 54 years). Median functional warm ischemia and asystolic times were 36 and 25 minutes, respectively. TA-NRP had a median duration of 125 minutes. Twelve recipients underwent direct transplantation, while four required ex vivo lung perfusion (EVLP). ICU stay averaged 6 days, with a 12.5% PGD 3 rate at 72 hours. In-hospital mortality was 6.2%; two patients(12.5%) died from infections post-discharge. Our findings suggest that prolonged TA-NRP does not compromise short- or medium-term LT outcomes.