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% YoY) and full-year revenue of $605.5M (up 37% YoY), demonstrating strong resilience and growth.

• 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.

• Continued expansion of OCS technology and NOP services, with clinical adoption gains, especially in liver transplants, and ongoing investments in innovation and infrastructure.

• 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.

Financial highlights

• Q4 2025 revenue: $160.8M (+32% YoY); full-year 2025 revenue: $605.5M (+37% YoY).

• Q4 gross margin: 58% (down 1.1pp YoY); full-year gross margin: 60% (up from 59.4% in 2024).

• Q4 operating margin: 13.2% (up 6.1pp YoY); full-year operating margin: 17.9% (up 9.4pp YoY).

• Q4 net income: $105.4M (includes $83.8M tax benefit); full-year net income: $190.3M (includes $82.8M tax benefit).

• Ended 2025 with $488.4M in cash and cash equivalents.

Outlook and guidance

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

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

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

• 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, new clinical programs, and international expansion.