Earlier today, TransMedics released financial results for the quarter and full-year ended December 31st, 2025. These results were achieved despite external challenges earlier in the year that were designed to distract and disrupt our sustained and transformational growth. Total revenue for Q4 2025 was $160.8 million, representing approximately 32% growth year-over-year and approximately 12% sequential growth from Q3 2025. transplant revenue grew approximately 11% sequentially to $155 million, while OUS transplant revenue grew approximately 33% sequentially to $5 million.
Finally, we delivered an operating profit of approximately $21.3 million in Q4, representing approximately 13.2% of total revenue for fourth quarter, while making substantial investments to fuel our growth. Total revenue for the full-year 2025 was $605.5 million, representing approximately 37% growth year-over-year. We delivered operating profit of approximately $108.6 million, representing approximately 18% of total revenue for the full-year 2025. We are very pleased by our strong performance in Q4 and full-year 2025.
As we do every year, I would like to share full-year OCS transplant volumes and overall U.S. Here are the key highlights: For the 3rd consecutive year, we grew the total OCS transplant volume. As of February 22nd, 2026, our internal company and UNOS database records show that OCS was responsible for 5,139 transplants performed in the full-year 2025, up from 3,735 U.S. Importantly, for the third consecutive year, we saw growth in overall U.S.
| Metric | Period | Current guidance |
|---|---|---|
| Full-year revenue | FY2026 | guidance issued above street; reflects underlying liver/heart growth, clinical trial enrollment, and Italy in the back half |
| Operating margin vs prior year | FY2026 | approximately 250 basis points of contraction year-over-year, with almost 50% of incremental investment from ENHANCE/DENOVO completion, OCS Kidney development, and next-generation OCS 3.0 |
| Gross margin | FY2026 and beyond | around 60% long-term, with potential near-term volatility from international expansion |
| Metric | YoY | Note |
|---|---|---|
| Q4 total revenue | approximately +32% | Q4 recovery from expected Q3 seasonality, fueled by growing OCS case volume and increased clinical adoption. |
| Full-year liver revenue | almost +49% | Strong liver execution and clinical leadership; OCS liver represented 4,197 transplants or 36% of U.S. liver volume, up from 26% in 2024. |
| Full-year heart revenue | almost +15% | Continued strength in heart; OCS heart represented 854 cases or approximately 18% of U.S. heart volume, modestly up from 17% in 2024. |
| Q4 logistics revenue | +32% | Continued expansion and strong utilization of the aviation fleet, with 22 owned aircraft and approximately 80% NOP air-transport mission coverage (up from 75% in Q4 2024). |
| Q4 net income | significant increase to $105 million | Strong operating performance plus an $83.8 million income tax benefit mainly related to the release of the valuation allowance on deferred tax assets. |
| Full-year operating margin | expanded from 8.5% to 18% | Operating leverage as revenue scaled, supported by strong cost management discipline, even as gross margin improved only modestly. |
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| ENHANCE Part B competitive obstacle | — | The styrofoam cold static storage box maker refuses to randomize against OCS; TransMedics has a plan to bypass this with transplant programs taking control and an FDA-acceptable control arm. | — |
| Market expansion vs share taking | — | Since 2022, U.S. liver, heart, and lung volumes grew 25% with OCS NOP but would have declined approximately 1% without it, supporting management's view that it is expanding the overall market, not just taking share. | — |
| NOP Connect 2.0 digital ecosystem | Discussed on prior call as providing operational efficiencies | The vast majority of cases now flow through NOP Connect 2.0, showing efficiency in management and billing, described as TransMedics' second legacy after OCS, though still early days. | — |
| U.S. transplant system modernization | — | TransMedics supports CMS proposed language and Senator Wyden's bill to open the closed transplant system to more competition and transparency, viewing it as a win-win to play a bigger role while supporting existing OPOs. | — |
| OCS Liver registry publications | — | Aggregated thousands-of-cases registry publications showing statistical superiority in key liver outcomes are under review at high-impact journals, on top of 14-15 existing publications; timing cannot be commented on. | — |