Normothermic regional perfusion in kidney transplants with donors after controlled circulatory death: Functional benefits and safety in older recipients.

Normothermic regional perfusion (NRP) is increasingly used in controlled donation after circulatory death (cDCD) to mitigate ischemia-reperfusion injury. While NRP reduces delayed graft function (DGF), its impact on long-term outcomes, particularly in elderly recipients, remains uncertain. We retrospectively analyzed first kidney transplants from cDCD donors in a national registry (2015-2023). Outcomes after NRP were compared with rapid recovery (RR) using 1:1 propensity score matching based on donor/recipient age, comorbidities, and transplant year. A predefined subcohort analysis focused on recipients aged ≥65 years. Endpoints included DGF, hospital stay, renal function, and 5-year graft and patient survival. Among 1414 transplants, 1153 were eligible, and 410 matched pairs were analyzed. DGF and median hospital stay were significantly lower with NRP than with RR (19% vs 34%; odds ratio for RR vs NRP 2.87; 95% CI, 2.1-4.0; P < .001 and 11 vs 13 days; difference -2.0 days; 95% CI, -3.6 to -0.4; P = .012, respectively). No significant differences were observed in estimated glomerular filtration rate trajectories or 5-year overall graft survival (P = .896), death-censored graft survival (P = .666), and patient survival (P = .981). Results were consistent in recipients ≥65 years. In this large real-world cDCD cohort, NRP improved early posttransplant outcomes without influencing midterm graft or patient survival.