Welcome to XVIVO Q2 report for 2024. For the first part of the conference call, the participants will be in listen-only mode. During the questions and answer session, participants are able to ask questions by dialing pound key five on their telephone keypad. Now, I will hand the conference over to CEO Christoffer Rosenblad and CFO Kristoffer Nordström. Please go ahead.
Thank you so much, and welcome to XVIVO's earnings call for the second quarter of 2024. As we see on the first slide, we have today's presenter here. It's me, Christoffer Rosenblad, CEO of XVIVO, and Kristoffer Nordström, CFO, today, calling in from Philadelphia. If we go to the second slide in the deck, we see Q2 financials at a glance, and I'm proud and happy to report the strongest quarter in XVIVO's history, and that Q2 shows improvement on top line as well as EBITDA. More importantly, the Q2 shows that XVIVO has a scalable business model with improving margins, with increasing sales, even though we continue and will continue to invest in the organization for future growth. Sales came in a record SEK 210 million. The gross margins are continuing to show strength.
We plan and reported that we plan to improve the abdominal gross margin to 70% at the latest in 2027, or earlier when we reach economies of scale in production, and we see that we continue to produce according to that goal. The EBITDA shows a strong improvement to 24, and Kristoffer Nordström, our CFO, will get into the details on sales, gross margins, and EBITDA later in this presentation. I also want to mention that the growth for thorax is picking up and mainly come from higher XPS activity during the quarter. We have historically seen solid growth from Europe on the XPS, and we now see that growth is coming more and more from the U.S.
There's a high interest from new customers starting EVLP programs, and we see that former low volume customers are increasing their EVLP activity level. With that, we go over to YTD financials at a glance. As you see on this, it's slide three, we see a similar picture, the first six months as we've seen in the quarter. And the key takeaways for the first six months are growth. Growth is still mainly coming from increased activity in existing customers and a stronger market. We continue to see high interest from new customers, especially after ISHLT in April. And we see that interest starts to get converted into active customers.
We can also conclude that sales from products is picking up faster than sales from services, even though we have a fantastic service offering with a very, very good quality and very good customer feedback. And even though we are investing heavily in, in mainly commercial and field force, we can conclude that the revenue model is scalable. In other words, we see that it gets converted to gross margin and EBITDA. Lastly, and most important to mention is that projects are progressing according to plan. The heart project is on time, and by that, the production capacity project, where we invest to scale up volumes, 10x of today's volumes for disposables, are running in line with communicate timelines.
I'm happy to report that the first milestone for the Kidney Assist Transport is met, and we now will have production volume for U.S. launch in Q3, probably after the vacation period in the U.S. And as we have reported earlier, the project for full-scale production of disposables for heart, liver, and kidneys is estimated to be completed end of Q2 next year, so we still have a year to go. And with this first two glances, we will go over to Q2 highlights on slide four, and then we can go directly into slide five, where we go over what happened. I know I mentioned the ISHLT last quarter, but some news needs repetition. So we start with the report from this year's ISHLT conference in Prague in April.
ISHLT is the largest and by far the most important conference for heart and lung transplantation. And I want to repeat again that XVIVO was the most selected exhibitor, and the result from the EU study with XVIVO heart technology was the most selected scientific session in the whole program. We also held two extremely well-attended industry symposia during the conference, where we got extremely good feedback from customers on the scientific highlights, and they said it was even better than most of the original program. And as I said earlier, we can already see in late Q2 the impact of the conference in an increased interest for our lung and heart technologies. I also again want to mention on slide six the fantastic results from the one-year heart study.
It's and I never seen such good results before in my life, and there are three key takeaways from this study. One, it is, again, to our knowledge, the first randomized controlled trial with the superiority designs in heart to lung transplantation, which shows the confidence the clinicians have in the XVIVO heart technology. Two, the HOPE group, where HOPE stands for hypothermic oxygenated perfusion, in other words, pumped with XVIVO technology, showed an improvement of 61% for severe PGD versus the control group. This is a highly important improvement provided that PGD is the leading cause for early mortality after heart transplantation, and we know that PGD negatively affects long-term survival. Three, the takeaway is that all hearts were deemed transplantable after perfusion. This is important to highlight since cold perfusion offers safety advances during transportation.
On top of the NHP 2019 trial presented in during ISHLT, I also want to mention the PEGASUS trial or Pegasus in English, study by Professor Lebreton, and it's progressing according to plan. The study is designed that with transatlantic flight on commercial airlines show that more than 12 hours of transport is safe, and it's feasible in a practice setting. We think that even though this trial is comparably small with seven patients, that this can show and revolutionize how heart transplants logistics are performed. It's the first proof that our technology can enable both patient benefits and cost benefits for the healthcare systems around the world. With that, we turn to slide seven, where we also will still stick to heart and some great news around DCD donors and heart trials.
Approval has been granted to study DCD direct procurement. Direct procurement means that transplants are made without prior NRP, similar. The portion of the donor pool that are coming from DCD is comparably large in some countries, and it's growing very fast. So for example, in the U.S., it's already 36%, and in Benelux, it's approximately 58%. And if we want to substantially increase the number of transplants, we need to prove that DCD hearts can be transplanted in a safe, cost-efficient, and practical, feasible way with good patient outcome. This study is designed to show that. The earlier experience we have from liver and kidney shows with very good clinical outcome that it is possible, so the concept in itself is proven.
We have also seen in preclinical settings on hearts that using the XVIVO heart technology on DCD direct procurement shows good results. And lastly, as we have reported earlier, the DCD study or the study in the U.S. for regulatory approval, there we also include DCD hearts. The company hopes and believes that we will have good evidence when those two studies are concluded. And with that, we will turn over to another organ and more precisely, the lungs. We have seen in both Q1 and Q2 good results and increased usage, and we can see that the pressure from mainly the American political system to increase the number of transplants has had a very positive impact on EVLPs for lungs.
We can also see that the hub models we have talked about before or centralized perfusion models help to drive growth. We now have the bridge in Scandinavia active recruiting, and we know Paris has a hub, which now have three clinics participating, which all of those hubs enable that we can make more transplants with less resources. I also want to mention in the U.S. that we have deeper collaboration with, for example, Lung Bioengineering, that is also showing to be very fruitful. The other trend we see with a positive ISHLT and more feet on the ground is an increasing interest for EVLP and setting up EVLP programs.
As I mentioned in the beginning, we have seen that some of that interest has returned into more usage of EVLP, and some of the interest has resulted in new EVLP program being set up in both Europe and the US. And this is really exciting news, and we know that with more EVLP programs, we get more patients, we get a chance of a lung transplant and hence not dying, waiting for a new lung. And with that, we go straight into the abdominal portfolio. During the last year, we've seen more than 20 publications on the liver assist technology, showing improved patient outcome on both DBD and DCD grafts after transplantation. This quarter, long-term survival data was published on extended criteria DBD livers, and with very good results.
We are very pleased to both read this and very proud of what our technology can accomplish. We can see in the study that the five-year outcome for organ survival is 87% in the Liver Assist group, which is, in itself, a very strong result. I think it get even more clear if we shown it compared to the control group, where the result was 52%, which was standard of care, which is the beer cooler type of transport with the on ice with a solution. I have mentioned before also that we last quarter we had a Lancet publication showing that livers can be safely perfused up to 20 hours, and we can eliminate, if we use this technology, the need of nighttime liver transplant.
I think this, again, is a great example where we can improve that or show that we can get improved graft survival and also improve work-life balance for our customers. Lastly, as stated earlier, the production scale up times 10 of today's volumes is progressing according to plan. We have reached our first milestone, and hence, we're now ready to launch Kidney Assist Transport also in the United States. And with that, we leave the highlight section, and we turn into our clinical pipeline. This is a divider on slide 10, and we can go straight, actually, to slide 11, where we see the regulatory status and the clinical trials and our tentative timelines. I'm happy to report that nothing has changed since last time we met, so I will repeat what I said in April.
In the US, the heart trial is progressing according to plan, and our clinical team in the US is working very hard to include all clinics into the trial. The interest is very high to be part of the trial, and we are literally doing our utmost to make sure that we can meet that interest. As also mentioned before, in Europe, we have handed in our technical documentation for review according to our time plan. We are aiming for a CE Mark in Europe in Q4 2024. Important to mention is that we can't affect the review time to 100%. The good news is that the notified body has been very responsive, and even though they have a high workload under MDR, they've been really working together with us. Also, the Swedish MPA is responsive and delivering on time.
The insecurity we deem we face is that how fast EMA or the European Medicines Agency can handle the review. We have done what we can, and in other words, handing in product and clinical files with good quality and on time. In Australia and New Zealand, we have already high usage of the product, the heart product in this case. The regulatory approval will be pending the CE mark in Europe, but we are encouraged to see the continued high usage of approximately 30% of all hearts in Australia going on the XVIVO heart technology on a compassionate use. We have also previously reported that the Liver Assist have been granted breakthrough device designation by the FDA. This will mean that we get a faster route through the FDA PMA process.
It is also a quality stamp that the products are innovative and fulfill a need on the market. We have started to invest in an organization to run the study, and we are preparing the FDA documentation. The aim is to hand in the IDE application at the end of this year. With that, we have concluded the first part of the presentation, and I will hand over to my CFO, Kristoffer Nordström, who will present the financial performance of the quarter.
Thank you so much. Yes, as Mr. Rosenblad started off this call, it was, as you all know, a financially strong quarter. We're very satisfied and happy over that. We're doing many things right at the moment, and that starts to pace off, and we should, you know, just continue to deliver on that way, of course. Sales came in on record levels in Q2. Same did EBIT, same did EBITDA, but last but not least, also our operating cash flow was also strong, which is delighting, of course. So to the numbers then. Net sales in Q2 came in at SEK 210 million, and that is a new record, as Christoffer mentioned. Organic growth, 35% in local currencies. Overall, gross margin, also prices really, 75%, same as last year.
EBIT in Q2, 16% versus 10% last year, that, that's mainly driven by our increased sales, although we continue to invest in the organization. But as you know, we have done that in a fairly controlled way so far. EBITDA in Q2, 24% versus 19% last year. So overall, a good quarter, where we continue to sequentially improve both top line and profitability. Also, looking at the year-to-date numbers, it looks good. So we reached SEK 396 million in sales, and that's a growth of 34% in local currencies. EBIT, 13%, and EBITDA, 22%, and both these measures are significantly better than last year. Should touch a little bit up on the outlook.
When we, when we look ahead into the next quarter, Q3, it is worth mentioning that the third quarter is normally a sequentially weaker quarter than the second quarter. That's our experience. And most often, this is due to things that are a little bit out of our hands, such as, you know, summer, lower activities during the summer, the sites, et cetera. But we will do what we can to keep the momentum, of course, but at least from the past, that, that has been our learning. When it comes to, to EBITDA, the quarter was a record, as, as mentioned, 24%. This measure can, of course, go up and down a bit, quarter by quarter, and, and we continue to invest and grow our organization, as you know.
But I think what we did this quarter was that we clearly demonstrated that this quarter showed that our current business model is scalable, and it is profitable already at these lower levels of sales that we are seeing this year and last year. Moving over to thoracic and back to Q2 again. So very strong quarter. Sales coming in at SEK 141 million. Organic growth for disposables was 40%, and the main driver, similar to previous quarters, is EVLP, which is great, and specifically in the North America. In North America, we saw EVLP grow 40% in Q2, and actually more than 60% year to date. So a very strong development and a very good.
We start to see the results now from the reorganization that we did last year. PERFADEX sales, not forget, grew 12% versus Q2 last year, and have grown 12% also year to date, and that's driven by the increase of number of transplants, but also our price increases. On the sales side, it's also great to share that we had heart sales in Q2 of SEK 19 million, and that comes from a variation of compassionate use, supported by the strong evidence presented at ISHLT, but also revenue from our U.S. heart trial. So we start to see some good numbers now also on sales, despite the fact that the products are not yet approved anywhere. Gross margin disposables, Q2 was 85%, and that's in line with previous quarters as well. Moving over to abdominal.
Net sales amounted to SEK 47 million, which represents another record quarter as well. Organic growth, disposables, 36%. If you also include machines, which so makes a little bit more sense on the abdominal side, because here, it's more frequently that we actually sell Liver Assist devices. If you include machines, the sales growth was actually 53%, which is very strong. Liver stood for 72% of total abdominal sales, and kidney sales came in about SEK 10 million, which means that we're close to SEK 20 million year to date.
As Christoffer mentioned, we have increased our production capacity, and improved that capacity in Q1, Q2, and we do now have supply, so we can start to reengage with customers who has expressed the interest in our technology, which is, that's what we have waited for, obviously. Gross margin disposables came in at 63% versus 70% last year. It's weighted down, temporarily, by costs associated with our interim solutions for production capacity, and then I think you can expect to see that also in Q3, Q4. We need to put in some extra dollars, to ensure that we can continue to provide, capacity. It's as simple as that. Final, business area, moving over to services.
Sales in Q2 came in on SEK 23 million, and that came from 126 recovery cases, and that represents a modest sales growth, 10%. Transplant activity at our customers increased in Q2, but we still suffer from lower cases versus last year due to the loss of two high volume centers in 2023. So we have added new customers in Q4, but we have simply not yet recovered and grown our case volumes, and that's also reflected in the numbers, of course. As we continue to work to develop our market strategy for organ recovery, and we'll focus on that in Q3, Q4. We are also working and looking into expanding our offering, not only—so not only offering organ recovery services, but we are looking into NRP.
We have had a very successful pilot case with a prominent U.S. hospital, and there is interest from other hospitals to have us helping them execute on such a program as well. We are also looking into EVLP perfusion services. Hope to see a pilot in the second half of the year there as well. Most of the hospitals, they run their EVLP programs perfectly well because we are training them, and we are there for them, so to say. But if there are cases where new centers wants to come aboard and they want us to also offer perfusion services, we should absolutely be able to offer that as well. So that's what we're looking into.
Another initiative, final comment on services, is also that we want, and we will start to engage our XVIVO services team in... with our heart trial centers. So centers who want to learn how we, or, or I should say, centers today, wants to learn, how we can help them grow their thoracic transplant programs, not only after the trial, but also during the trial. So that, those are dialogues that we are also having at the moment. So, we are, you know, cautiously optimistic, that we should end this year, on a high also for services, no doubt about that. Moving over to EBITDA, just, you know, we have said it all, I think, a solid quarter, 24%. Rolling twelve, we're at 20%, and the trend develops nicely.
We have stated it, you know, many times before, but our mission is to continue to improve EBITDA year-on-year, absolutely. We will do this step by step, and what we want to do is to maintain a healthy relationship between sales growth and our mission to sales growth and profitability. And we show this quarter that we're definitely on the right track today. Final slide on my side, as always, the financial position and cash flow. I mentioned it in the beginning, good quarter here as well. Q1 was cash positive from operating activities, SEK 25 million positive. Investment amounted to SEK 48 million, primarily spent on the U.S. clinical trials and investments in machine fleet, and that led to total cash flow of -SEK 27 million.
We ended the quarter with a solid cash position of SEK 481 million. That was everything from me for now. I'm happy to receive questions. Giving the word over to you again, Kristoffer.
Thank you so much, Nordström. We will just have two quick slides on the outlook, and I will start, as always, on the long-term pictures. We're here for the long game, and it's important to establish the long, long-term picture. The demand for transplant is still 10x higher than supply today, according to the WHO. I also want to mention that the sales value of machine perfusion is approximately 10x versus static cold. So there is a large market opportunity and a huge opportunity to improve life for patients with end-stage organ failure. Machine perfusion and our service models have proven to increase the number of organs to be used for transplantation, especially in the fast-growing DCD organ pool.
The main growth driver are superior clinical results from machine perfusion and the fact that service models reduce complexity and time for the transplant clinic. Hence, machine perfusion and service models on normal and DCD grafts will drive growth in the near to medium-term future. But lastly, to grow all the way to 10 x the number of transplant, the company believes is possible with the current human donors. However, over time, new innovative sources of organs will probably be used. One example is xenografts or grafts from other animals than humans. For both machine perfusion and new sources of organs, XVIVO has proven a proven product line, and this puts XVIVO in a unique position on the market today.
If we go to the next slides, number 21, this is more of a near-term outlook, where I want to say that we will keep razor sharp focus on our key priorities, which are, we see that after ISHLT, we will have increased focus and actually spend more resources on both the US heart trial and launch preparation in Europe and Australia, New Zealand. For the same reason, we will also expand our global market leadership in lung by driving a further EVLP utilization. Here, the investment is mainly in marketing and field force capacity. I said it many times before, but ramp up production capacity is the most important project we're running right now to meet the increased demand we see for both kidney and liver. So we are focusing on that as well.
Lastly, we have a clear focus on our service support for the growing US transplant programs. We will continue to drive pilots and develop successful product service revenue models to meet the logistical needs we see transplant clinics have today to grow their programs and not burn out their staff. With that, I will hand over for questions and remind everyone the reason we are here, and it's that nobody should die waiting for a new organ. Thank you so much.
If you wish to ask a question, please dial pound key five on your telephone keypad to enter the queue. If you wish to withdraw your question, please dial pound key six on your telephone keypad. The next question comes from Simon Larsén from Danske Bank. Please go ahead.
Yes, good afternoon, gents. Two questions from my side, please. First, maybe on the lung side of the business. So as you said, two new XPS accounts that went live here during the quarter. I mean, would you say that these have contributed meaningfully to sales in the quarter, or should we expect them to ramp up further here during the back half of the year and support continued strong growth for the thorax segment?
So thank you. Thank you. Great question. No, when they are active customers, they have contributed already during the quarter. So that's the definition of a new customer, that it's a meaningful contribution. So what we are trying to do is build as many active customers as possible to drive EVLP usage.
Yeah, yeah, yeah, of course. But, but I mean, I think, or I, I guess they are maybe not sort of spending as much as a mature customer, yet, right? Or am I wrong?
I got the question. Yeah. I mean there will be a ramp-up process, for sure. It's, it's hard to say right now exactly how that would look like, but yes, we, we anticipate that to be ramping up over time.
Yeah. Okay, and I leave myself with two questions. So my final one, on the production scale-up project, so you're obviously pushing out the timeline here a little bit into end of Q2 next year. So I'm just trying to understand the risk of the current timeline that you have. So what are the remaining boxes that you have to tick, so to speak, in order to finish this project? And is there any specific critical roadblock that you have to overcome to get to the factor 10 in disposable volumes here?
Thank you, Simon. I just want to be clear that when I left last year, I said it will take all in all two years. So this is the timeline we always counted on.
Okay.
But the first milestone was June this year for kidneys transport, where we scale up the current-
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Interrupting with what?
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The line is open. Please state your name and company before we ask you a question, or something like that.
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You've been muted. To unmute yourself, press star six.
I hope I'm back here. So, my, to answer the question, we are running according to the communicated time plan. The other thing, the part of the question where the critical components, there are a couple of key ones, which is one, investing in production equipment, which we have concluded. Then there is, of course, scale-up and validation of all production equipment and making sure we get through the notified body, FDA, et cetera. But we don't foresee any problems, and we think we have... Do you hear anything?
Yeah, I think you, you broke up maybe a little bit, but I think you, I can hear you now.
So, my point is that we have. We are right now. We have invested in production equipment, and we are validating that production equipment and improving the production of the products. But right now, we don't foresee any delays in the project, and we are, as I stated, according to where we should be at this stage.
Okay.
But it's all in all, for three products, it is unfortunately a two-year project. That's the time it takes, unfortunately, to scale up this type of sterile production.
Yeah, yeah, makes sense. Maybe a super quick one for Mr. Nordström, maybe on the STEEN solution. Have you increased prices or anything? Yeah, what's the price component for the growth of the machine perfusion consumables in the quarter? [inaudible]
The next question comes from Jakob Lembke from SEB. Please go ahead.
Hi, and good afternoon or good morning, wherever you are in the world. My first question is on the lung machine perfusion. Obviously, we're very strong here in Q2. My sense is that this is mainly driven by increased utilization at existing customers. But when you discuss with these customers, do you have any insights to why—what is driving this sort of sudden large increase in utilization?
Thank you for your question. I think there are mainly two reasons. One is the pressure, and this is mainly in the United States. One is mainly the pressure from American politicians from the beginning, but now the transplant system that put pressure on more volumes for transplants, and that increased then the interest for doing an EVLP, which is exactly the aim of an EVLP, to get more organs available. The other thing that drives a lot of interest, I think, is what we do, especially after ISHLT. We have seen a huge interest for this technology that you can safely transplant more organs, that would previously not be used for transplantation. So those two main reasons we see for increased usage.
And then I think running an EVLP is, of course, take some extra headcount, et cetera. So the hub models helps to reduce the workload, and reduce workload will over time translate to higher usage.
Okay, and then just a short follow-up on that one. I mean, given that it seems like it's mostly external factors driving this, and you only recently did this reorganization in the U.S., is it fair to assume that growth perhaps could be even higher here going forward when you sort of start to push it more and gain new accounts and so on?
Yeah, very hard to speculate on that one. We are very happy to see the progress in our sales team, especially in the US, where we have made a real turnaround. We see that we now can cater to the high interest, and we of course hope for the best, but it's hard to speculate where we see this going in the future. But we see a good momentum. We will continue to work hard, and we see where we end up.
Okay, fair enough. And then, moving on to kidney, when should we expect contribution from new customers now that you are able to take on those?
We believe that we will have the highest interest after Labor Day in September, because from now on, there will be a certain amount of holidays in the U.S., on our customer side, which is starting up new programs. So I think contribution as of September is good to cater in.
Okay. And finally, I have a few questions on heart. Maybe first on the revenue side here this quarter. Should we expect the Q2 revenues to be sort of the new normal, or should it sort of come down a bit once recruitment in the US trial has finished?
From now until the trial is finished, we can probably conclude this level. And then when the trial is finished, it depends on the continuous protocol. That is something we are in a dialogue with the FDA, how that continuous protocol and what number of transplants that will be. So that, so when the trial is finished in what we think end of March next year, it's hard to speculate at this moment on what the level will look like. But up until then, I would assume the same level, yes.
Okay, but just looking at the revenue number here in, in Q2, if you continue at this pace, you will probably finish recruitment before March next year, right?
Yeah, we had a high, high, high level, definitely. Now, I always—I want to stick to the timeline we have, so to say, because it's—you never know what happens in a trial. But I agree, there is a high interest, and right now, the inclusion in the trial is very dependent on how hard we work, actually, and what resources we put to include new trial centers into the study. But so far, the team has done a fantastic job. I'm truly proud of them.
Okay. And if we move to Europe for heart, how is the discussion with potential European customers? Sort of, do you have any new insights to what expectations we should have for heart in Europe once you have launched it?
We are preparing our launch plan right now. I will come back in Q3 and Q4 with more insights, but the good news, and you saw the trial on starting now on direct procurement, DCD, for example, we have reported earlier on the PEGASUS or the going over the Atlantic in a commercial flight trial, et cetera. The interest from the European trial centers and the European heart transplant community is very, very high for use in this product. So that is definitely what we see right now, and they wanna push the boundaries and see what this technology really can accomplish.
We are in that work right now to conclude how the launch plan will look like and to give you more insights, but I need to come back in Q3, Q4 with a more precise answer on expectation, on activity level, et cetera.
Okay. And finally, just a short one on this new DCD heart trial. Will there be any additional costs for that trial, and will you earn any revenue from the consumables in the trial?
Prior to CE marks, we won't earn any revenue on it. There will be some additional costs, but they are, in relation to the other trial costs in U.S., et cetera, handleable and modest.
Okay. That's all for me. Thank you very much.
The next question comes from Maria Vara, from Bryan, Garnier.
Hi, good afternoon. First of all, congratulations on the results, a very strong quarter. I just wanted to touch a bit on the service business. I think it's great, these new initiatives you're looking into, but I was just wondering, you know, how we'll see this actually impacting revenue and of course, gross margin. You can give some color on this, please.
Thank you, Maria. Great question. We have a very high-quality service where we have honestly had a bit higher hope on the revenue side. We think it's definitely worth that. It's a good one. Where we will work very hard is to incorporate it more into a product service revenue, where we think its place is better, and we will generate more revenue. We will start that work, and we have actually already started that work, so I hope to see result of that soon. In terms of gross margin, the how we report right now, I think the gross margin we see is reasonable to think that we will keep over time. I hope that answers your question.
Yes, perfect. Thank you. And just a bit on the heart trial recruitment process. If I remember correctly from the last quarter, you mentioned that 10 out of 20 clinics already initiated the trial. Do you have any update on these numbers and, well, any initial experiences or something you want to share?
Yeah, thank you. Yeah, I can share. We are halfway on-- we are half time and halfway in terms of enrollment, and we have included more trial center. I don't know the exact number right now, today, but we are continuing to include trial centers and actually as fast as we can, because it takes some time to get all the paperwork done, ethical done, and get all the training done. So the team is working really hard. The other part of the question, I mean, the initial feedback has been almost overwhelming from the users. How easy the product is to use, how it basically fits.
It's not much bigger than a beer cooler, which you used before, and it doesn't need much more work, actually. It's a bit back table when before you go on the airplane. So far, the feedback on the product from both Europe and Australia and the United States has been almost overwhelming. So we have high hope that this will translate into a successful launch on all continents over time.
Great. That's great to hear. Well, that's everything from my side. Thank you very much.
Thank you.
The next question comes from Johan Unnérus from Redeye. Please go ahead.
Thank you, and congratulations on yet another strong quarter. To start off with a few questions then, and on the softer side, earlier, the previous quarter, you, I remember you referred to somewhat soft conversion of the pipeline in the services, and this seems to continue in Q2 to some extent.
Mmm. Yeah, yeah. I mean, the selling in a service takes a slightly longer time, and as you remember, we did a reorganization of the sales team in late Q4 last year. We see earlier results on products basically than we see on services. But I'm confident that we will see good results over time for all our segments or areas. But definitely it is true that selling a service takes a slightly longer time than selling a product, which is more instant.
Should we expect more support from the services side in terms of pipeline conversion and effect of the reorganization fairly soon? Or is that something that will happen more into 2025, perhaps?
I think we will see a gradual improvement during Q3 and Q4. The long-term effect of a better product service revenue, I think we would need to look more into 2025, or later. And I think that also, when we talk about service, to remember where I think the real holy grail, so to say, is definitely together with heart, the heart project, or the heart product when we launch that. So that will be the real litmus test to the service organization, where I know that if we're gonna scale up the number of heart transplants dramatically in the US, what I hear when I talk to customers is that then we need to have a very good service attached to it.
But that being said, we are still expecting to see a gradual improvement over time.
Already now in the Q2, you had another quarter of which was very strong overall sales, and to some extent, this is somewhat ahead of scaling up the commercial structure. I suspect that we should expect to see more OpEx growth reflecting the commercial U.S. efforts, perhaps already in Q3. Could you provide a bit flavor on what to expect on that side?
Yeah.
Yeah.
Definitely. Thank you, Johan. Yeah, definitely. We have the bigger picture first is that we have, as I said, a huge market potential, which we want to invest into. Where we believe the market is in unit 10 x bigger over time than what we see today, and in value a lot more. So that's what, of course, what we weigh towards the EBITDA 30% 2027 goal, so we always have a trade-off there. In terms of the scale-up of field force, we have two big milestones coming up. One is, of course, the kidney launch in the U.S., where we will invest heavy towards, and the other one is the heart launch in Europe.
We will see definitely a phase of investment into field force capabilities to make sure that we have a good launch for those two, two products in those two regions.
Thanks. That's helpful. And also regarding the discussions and the communication with the FDA regarding continuous protocol, you are in discussions, obviously, and what can we expect feedback from that before the study concludes, perhaps in March, or is it difficult to put a timetable on that?
Yes, it's difficult to put a timetable on it. Wise from experience, it's we will probably know when we near or are at the end of the study.
Yeah. Seems reasonable. And, and what about in Europe? It sometimes—I mean, you had very good study results. The initial interest in heart seems to be very strong, but Europe can sometimes be a tricky market to launch in. What’s your take and approach in terms of key countries and type of centers?
You're right. Europe is probably the trickiest market to launch in, with numerous different countries, numerous different systems, reimbursement being different in every country. So you're absolutely right. We will have a selected approach where we will launch almost center by center, because we have done the trial in eight countries, so we have a pretty good geographic footprint or spread already on heart and experience on heart in Europe. But we will have a very targeted approach when we launch the heart in Europe due to the difference in systems and reimbursement country by country.
We have a few target countries, like, for example, France and Belgium, where we have very high interest, and we also know in Germany, and we now start to see high interest in UK. So we will make sure that we target enough and have a very clear focus when we launch the heart product.
Very good. Very useful. Thanks. That's all from us.
Thank you.
The next question comes from Ulrik Trattner from Carnegie. Please go ahead.
Thank you very much. Hi, Chris and K ris. A lot of my questions have already been answered, but I have a few additional ones. Abdominal, and we can see obviously the sequential production improvement and deliveries, and obviously, customers out there really want to buy your technology, and you're scaling up production. But are you, as you mentioned, that you are hitting your first milestone right now, does that mean that you're ready to deliver on large OPO contracts from the second half of this year? Or should we expect it to be more reasonable to assume that it should be tilted towards 2025, when you have clear all obstacles in terms of production?
Thank you. That was a very good and clarifying question. The quick answer is that we should expect it after Q2 next year, and the reason is twofold. One is we have increased with the current production. We have increased quite dramatically, but not as much as we can go straight to the OPOs. So we're not there yet. There might be a couple of pilots. The second reason is that we want to collect more clinical data on US ground, on kidneys, and that is best done in the clinical setting, hence at the clinics. So those are the two main reasons why I would expect that maybe in a year rather than now.
Okay, great. Thanks for clarifying. And a follow-up question on the commercial launch of Kidney Assist Transport in the US and expanding your service offering. Is there more meaning for a service organization to expand within thoracic rather than in abdominal, or are there similarities where you have high synergies, especially for the KAT machine? I think it's obvious if we're looking in hindsight on how you have delivered in Italy, that a perfusion service is a good way to get traction, but is it as important for the KAT machine as it is for the rest of the products?
That is, that is a great question. I believe that due to the OPO system, that they are fairly used to pumping kidneys, but that being said, all OPOs are not providing pump services, and all kidneys don't go through OPOs. So I believe over time, that will be important as well. Today, as I said before, we are focusing on scaling up the launch and gather more and more clinical data on U.S. soil, which looks very promising so far, presented at the ATC from one center. So this will not be our focus in the launch phase. What we will focus on, though, with the Italian model or perfusion model, is on the lung side, where we will pilot that in the U.S.
But to answer your question more straight, we will not do it the next year for kidney, but we believe over time that that will be an important component also on the Kidney Assist Transport launch.
Okay, great. Thank you very much. And last question on my end would relate to liver and submitting the IDE, and liver being an important product and the U.S. market being a huge commercial potential here. So what's left for you to submit an IDE?
There are a couple of tweaks on the product and the documentation to fit the FDA better that we need to do. One example being that the Liver Assist we have in Europe can do both hypo and normothermia. What we plan to do, where we have the best clinical result is on hypothermia. We need to, for example, limit the software so it can't go over certain degrees. So there is a couple of reworks on the product and a couple of clarification on the documentation to be done before we can hand in the IDE.
Okay, great. That was all question on my end, and thank you very much, and enjoy your summer.
Thank you very much. I hope you, too, enjoy your summer.
As a reminder, if you wish to ask a question, please dial pound key five on your telephone keypad.
Thank you. I was just gonna say we are-
The next question comes from Filip Wiberg from Pareto Securities. Please go ahead.
Hi, guys. Just two questions to end here. So one is around the European centers that you talked about that you're gonna focus on initially with the Heart Box-
Yeah.
So, in these eight countries. So, what kinds of volumes? Do you have any rough estimate of what kinds of volume they have? How many heart transplants they perform?
I don't have it right now, but that's a great question. The centers are high volume centers in Europe. The exact number and the portion of the total European heart transplants, I need to come back with that at next call, so we clarify that.
All right. All right, thanks. And just the other one, if there were any sort of one-offs or extraordinary revenues in the quarter that we should keep in mind now going forward. So, say, it's academia orders that were pushed or other things like that.
No, there were no such orders. The only thing of extra that performed a little bit better than we thought was, of course, the heart trial in the U.S., where we have the cost recovery model and charge, if that could be considered extra, but that was the only thing that were out of what we thought.
Okay. Well, thanks very much. That's all from me.
There are no more questions at this time, so I hand the conference back to the speakers for any closing comments.
I want to thank everyone for listening to this call, and remind everyone that on October 24, we come back with the Q3 report. We hope to have you all there listening to us then, and with that, I wish you all a great summer. Thank you so much.