Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

Abstract

Background. The SherpaPak Cardiac Transport System is a novel technology that provides stable, optimal hypothermic control during organ transport. The objectives of this study were to describe our experience using the SherpaPak system and to compare outcomes after heart transplantation after using SherpaPak versus the conventional static cold storage method (non-SherpaPak). Methods. From 2018 to June 2021, 62 SherpaPak and 186 non-SherpaPak patients underwent primary heart transplantation at Stanford University with follow-up through May 2022. The primary end point was all-cause mortality, and secondary end points were postoperative complications. Optimal variable ratio matching, cox proportional hazards regression model, and Kaplan-Meier survival analyses were performed. Results. Before matching, the SherpaPak versus non-SherpaPak patients were older and received organs with significantly longer total allograft ischemic time. After matching, SherpaPak patients required fewer units of blood product for perioperative transfusion compared with non-SherpaPak patients but otherwise had similar postoperative outcomes such as hospital length of stay, primary graft dysfunction, inotrope score, mechanical circulatory support use, cerebral vascular accident, myocardial infarction, respiratory failure, new renal failure requiring dialysis, postoperative bleeding or tamponade requiring reoperation, infection, and survival. Conclusions. In conclusion, this is one of the first retrospective comparison studies that evaluated the outcomes of heart transplantation using organs preserved and transported via the SherpaPak system. Given the excellent outcomes, despite prolonged total allograft ischemic time, it may be reasonable to adopt the SherpaPak system to accept organs from a remote location to further expand the donor pool.

Early elevated donor‐derived cell‐free DNA levels in heart transplant recipients following precision‐controlled cardiac transport system or ice‐cooled organ transport

“…8 Additional single center analysis also found similar results with additional findings of less need for blood products perioperatively and shorter ICU length of stay. 3,4 Lastly, registry analysis of more than 12 hospitals found that with improved clinical outcomes, hospital care costs were reduced by more than $26,000 dollars per patient. 9 Thus, the clinical and financial benefit of SCTS is becoming more evident.…”

“…2 Prior studies have demonstrated that the SCTS provides safe outcomes with respect to PGD and mortality. 3,4 However, to date, no studies have identified outcomes with respect to the relationship between elevated dd-cfDNA scores and different transportation methods including SCTS and ice.…”

Better Than Ice: Advancing the Technology of Donor Heart Storage With the Paragonix SherpaPak

“…Retrospective single-center experiences with Sherpapak technology have been reported by a small number of centers in recent years. [13][14][15][16][17] Early results from the GUARDIAN Registry were presented at the 2022 annual meeting of the International Society of Heart and Lung Transplantation. 18 At that time, the registry included data from 11 participating heart transplant centers in the United States, with a cohort of 156 patients receiving organs preserved with conventional cold storage (control), and 227 receiving organs preserved with the SherpaPak.…”

“…Retrospective single-center experiences with Sherpapak technology have been reported by a small number of centers in recent years. 13–17…”

Cutting the Ice in Donor Heart Preservation

“…In this edition of the journal, Zhu and colleagues from Stanford University report their experience with the Paragonix SherpaPak temperature-controlled hypothermic storage system for donor heart preservation and transport. 7 Its main stated advantage over traditional static cold storage (SCS) is more precise temperature control during transport with the heart maintained between 4.5° and 6.5° centigrade. The authors switched from SCS to using the SherpaPak system (Paragonix Technologies, Cambridge, MA) in June 2020.…”