Background: Uterus transplantation (UTx) provides women with absolute uterine-factor infertility (AUFI) the opportunity to carry their own pregnancy and deliver a child. There are multiple ethical and medical concerns associated with UTx. Since the last survey of US provider perceptions of UTx in 2018, there have been additional reports of successful transplantations and pregnancies. This study aimed to identify the perception of UTx among providers involved in the diagnosis of AUFI and on the transplant team to help us understand knowledge gaps and determine what barriers must be overcome for UTx to be used in general clinical practice. Methods: We administered REDCap surveys to conference attendees at the 2023 American College of Obstetricians and Gynecologists (ACOG) conference and 2023 American Transplant Congress (ATC). Participants were recruited by medical student volunteers. Results: Two hundred ACOG and ATC attendees completed the survey. Medical concerns related to UTx were reported by 42% of providers from ACOG compared to 22% of providers from ATC. Overall, 76% of participants agreed that UTx should be an option for patients with congenital AUFI. Lastly, 68% of participants agreed that the procedure should be presented as an option for transgender women. Conclusions: This study further elucidates the perception of UTx among obstetricians/gynecologists and transplant physicians. We found greater support for the procedure than in previous studies. This study also demonstrates provider support for presenting this procedure as an option for transgender women.

Background.: Abdominal normothermic regional perfusion (A-NRP) is postmortem perfusion of organs in the abdominal cavity and can be performed using multiple approaches, including femoral, intra-abdominal, and thoracic. Our program began with surgeons performing intra-abdominal cannulations with mechanical or balloon occlusion of the descending thoracic aorta for A-NRP procedures. Recently, we developed a novel technique using the descending thoracic aorta for arterial cannulation with right atrial venous drainage. Methods.: All A-NRP cases performed by Regional Perfusion Services from July 1, 2024, to June 30, 2025, were retrospectively reviewed. Intraoperative parameters were collected for comparison. Results.: During the study period, 28 intra-abdominal normothermic regional perfusion (IA-NRP) cannulations and 47 descending thoracic normothermic regional perfusion (DT-NRP) cannulations were performed by 16 surgeons. Median cannulation time was shorter in the DT-NRP cohort (8.5 versus 10.0 min; P = 0.016). Median time on NRP was shorter in the IA-NRP cohort (61.5 versus 91.0 min; P = 0.006). The median decrease in lactate was larger in the DT-NRP cohort (2.9 versus 2.3 mmol/dL; P = 0.024). The median number of transfusions used was higher in the IA-NRP cohort (3.0 versus 0.0; P < 0.001). The learning curves show a quicker descent in time and a lower nadir for the DT-NRP cases, indicating this technique may have a quicker learning curve and be a more efficient approach to cannulation. Conclusions.: DT-NRP cannulation can be implemented for A-NRP with a quick learning curve, providing an additional cannulation option to the IA-NRP approach.

Background.: Donation after circulatory death (DCD) is the major contributor to the growth in deceased organ donation in the United States. Normothermic regional perfusion (NRP) and ex situ machine perfusion (es-MP) have been vital for improving organ assessment and preservation in DCD donor organs. The procurement procedure and storage strategy for noncardiac donors were determined by liver transplant centers in the early era of machine perfusion in the United States. In this study, we analyzed the landscape of liver utilization from noncardiac DCD donors in the United States during the early era of machine perfusion. Methods.: All adult (18 y and older) DCD donors in the United States for which the heart was not used for transplantation from October 1, 2020, to December 31, 2023, were compared using procurement technique (NRP versus super rapid recovery [SRR]) and storage strategy (ex situ machine perfusion [es-MP] versus static cold storage). Results.: One hundred fifty-six livers were transplanted from 284 NRP donors (55% utilization) versus 2497 liver transplants from 9132 SRR donors (27% utilization). Es-MP was used in 19% (n = 30) of liver NRP cases versus 28% (n = 695) of liver SRR cases. Eight hundred fifty-one liver grafts (32%) were exposed to NRP, es-MP, or both. Conclusions.: Given the variation in liver graft management, further research needs to be conducted on the optimal strategies for using technologies such as NRP and es-MP in liver transplantation in the United States; better data collection is necessary to support this research and additional strategies are required to increase access to machine perfusion on a national level are needed.