TransMedics Group (TMDX) Q4 2025 earnings summary

Executive summary

• Achieved record operational and financial performance in Q4 and full-year 2025, with Q4 revenue of $160.8M (up 32% year-over-year) and full-year revenue of $605.5M (up 37% year-over-year), driven by strong growth across core business segments and OCS platform expansion.

• Net income for Q4 was $105.4M, including a significant one-time tax benefit from the release of a valuation allowance; full-year net income was $190.3M.

• Completed 5,139 U.S. OCS cases in 2025, a 38% increase from 2024, and expanded the aviation fleet to 22 aircraft, covering 79% of NOP flight missions in Q4.

• Announced new headquarters lease, adjacent land acquisition, and several key executive appointments.

• Received FDA approvals for OCS ENHANCE Heart and DENOVO Lung trials.

Financial highlights

• Q4 2025 revenue reached $160.8M, up 32% year-over-year and 12% sequentially; full-year 2025 revenue was $605.5M, up 37% year-over-year.

• Q4 operating profit was $21.3M (13.2% margin); full-year operating profit was $108.6M (18% margin).

• Q4 net income was $105.4M, including an $83.8M income tax benefit; full-year net income was $190.3M, both including significant tax benefits.

• Ended 2025 with $488.4M in cash, up $22M from Q3, reflecting strong operating cash flow.

• Gross margin for Q4 was 58% (down slightly year-over-year); full-year gross margin was 60%, up from 59% in 2024.

Outlook and guidance

• 2026 revenue guidance set at $727–757M, representing 20–25% growth over 2025.

• Gross margins expected to remain around 60% long-term, with some near-term pressure from international expansion and investments.

• Operating margins expected to contract by up to 250 basis points in 2026 due to transitory investments, but projected to approach 30% by 2028 as investments normalize.

• Strategic focus on accelerating heart and lung adoption in the US, launching NOP model in Europe, and preparing for OCS Kidney program launch.

• Growth drivers include increased organ utilization, OCS adoption, service revenue expansion, and international market entry.