To accomplish this, we've been deliberate, yet aggressive in our strategic investment in growth initiatives. We believe that 2026 is a critical and transformational year that stands to cement TransMedics' near, mid, and long-term growth trajectories and global market position. Our OCS Kidney platform will enable us to access the largest segment of the global transplant market, which is kidney transplantation. We strongly believe that once regulatory approvals are in hand, OCS Kidney will derive significant growth for our abdominal franchise.
As you can see from our ongoing growth initiatives, our focus remains on long-term value creation with continued investment across each pillar of our growth strategy. We are committed to executing our plan to drive significant growth for TransMedics and for the global transplant markets broadly. As I've stated repeatedly, I truly believe that TransMedics remain in the early innings of our long-term growth opportunity. Total revenue for 1Q 2026 was $174 million, representing approximately 21% growth year-over-year and approximately 8% sequential growth from 4Q 2025.
transplant product revenue grew by 22% year-over-year and approximately 7% sequentially to $102 million, while OUS transplant revenue grew approximately 39% year-over-year and approximately 17% sequentially to $6 million. We delivered adjusted operating profit of approximately $18.1 million in Q1, representing approximately 10.4% of total revenue in 1Q, while continuing to make significant investment to fuel our growth. Importantly, we ended 1Q with $462 million of cash and cash equivalents while making substantial investments in the growth initiatives above. fleet and improving efficiency and capacity by double-shifting a portion of the fleet to meet the growing clinical demand.
| Metric | Period | Current guidance |
|---|---|---|
| Full-year revenue | FY2026 | $727M-$757M (20%-25% growth, reiterated) |
| Long-term gross margin | Long-term | around 60% |
| Adjusted operating margin vs prior year | FY2026 | up to ~250 basis points below 2025 adjusted level |
| U.S. aircraft fleet | FY2026 | 22 operational aircraft maintained throughout 2026 |
| Metric | YoY | Note |
|---|---|---|
| Total revenue | approximately +21% | Growth led by strong liver performance, continued progress in heart, and increasing contribution from the integrated logistics platform. |
| U.S. transplant revenue | approximately +20% | Driven by increased transplant volume across liver (approximately $139M), heart (approximately $26M), and lung (approximately $2M). |
| International revenue | approximately +39% | Primarily driven by heart, with smaller contribution from lung, as the company builds its international presence. |
| Service revenue | approximately +19% | Growth driven primarily by logistics revenue, supported by increased utilization of the TransMedics aviation fleet. |
| Adjusted R&D expense | approximately +45% | Driven by continued development of the OCS Kidney program and next-generation OCS platform, plus product development activity in Mirandola, Italy, and headcount growth. |
| Gross margin | down approximately 331 bps to ~58% | Increased internal supply chain activity to replenish and position inventory for DENOVO and ENHANCE, continued NOP investment, and one-time items. |
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| CHOPS (Controlled Hypothermic Organ Preservation System) | Not yet unveiled | Unveiled at ISHLT in April; FDA-registered active cooling device (4-12 degrees Celsius) to serve as the control arm for ENHANCE and DENOVO, with IDE supplement to be filed within weeks and a 510 application planned for commercial use. | — |
| ENHANCE Heart and DENOVO Lung programs | Enrollment delayed by competitive dynamics | ENHANCE Part A enrolling slightly ahead of schedule; Part B and DENOVO to accelerate once CHOPS control arm is approved and implemented in early Q3 2026; 12-18 month enrollment timeframe maintained. | — |
| U.S. Transplant Modernization Act / CMS rulemaking | — | TransMedics submitted detailed comments in March 2026 advocating for new entities to become multi-regional or national OPOs, and intends to submit bids for decommissioned OPO donor service areas later this year or early next. | — |
| International / NOP Europe expansion | Italy NOP launch planned | Building infrastructure and staffing across four hubs in Northern and Southern Italy; agreement announced to invest in PAD Aviation to support a dedicated European organ transplant logistics network. | — |
| Non-GAAP financial measures | Not reported | Introduced adjusted R&D, SG&A, operating expenses, income from operations, net income, diluted EPS, and operating margin to provide transparency as the company incurs discrete strategic, corporate development, HQ relocation, and ERP implementation expenses. | — |