Introduction
Cardiac tissue preservation is an essential component of heart transplantation (HTx). Recently, The International Society for Heart and Lung Transplantation 2020 consensus statement on donor heart procurement recommended heart preservation at a temperature greater than 4°C, ideally between 5-10°C, to avoid freezing and subsequent irreversible myocardial cell damage. Paragonix Technologies Inc. SherpaPak (SP) (Boston, MA, USA) is a novel cardiac transport system with continuous, real-time temperature monitoring which allows for users to keep the recommended temperature for the duration of transport. The effect of SP technology has not been well described in the literature. We reviewed a series of cases at our single center to analyze the impact on primary graft dysfunction (PGD) and HTx outcomes.
Case Report
A review of 30 HTx cases at a single center since the first use of SP (November 2019 to October 2020) was conducted. Cases numbers of SP and ice in standard cooler box were 13 (43.3 %) and 17 (56.7%), respectively. There were no significant differences in pre-HTx donor and recipient characteristics except for donor heart ischemic time (SP 217.8 ± 14.7 vs. Ice 187.9 ± 44.0 minutes, p =0.03) (Table 1). There were no significant differences in PGD rates and length of stay metrics post-HTx.
Summary
In our case series, although mean donor ischemic time was 30 minutes longer on SP, post HTx outcomes including PGD rates were similar compared to traditional preservation methods. Further, larger studies are warranted to understand the potential benefits of this new technology.
Table 1Recipient and donor demographics and post heart transplant outcomes
| SherpaPak (n=13) | Ice box (n=17) | p value | |
|---|---|---|---|
| Recipient Age (mean ± SD) | 55.2 ±13.6 | 51.8 ± 13.4 | 0.51 |
| Recipient Female (n (%)) | 3 (23.1) | 3 (17.7) | 0.71 |
| Donor Age (mean ± SD) | 33.9 ± 5.6 | 29.8 ± 7.8 | 0.11 |
| Donor Sex Mismatch (n (%)) | 3 (23.1) | 5 (29.41) | 0.69 |
| Pre-Transplant MCS (n (%)) | 8 (61.5) | 14 (82.35) | 0.20 |
| Pre-Transplant VAD (n (%)) | 4 (30.8) | 11 (64.71) | 0.07 |
| Ischemic Time (mean ± SD) | 217.8 ± 14.7 | 187.9 ± 44.0 | 0.03 |
| PGD (Severe) (n (%)) | 1 (6.3) | 0 (0) | 0.38 |
| ICU Length of Stay (Post-transplant) (mean ± SD) | 12.8 ± 8.2 | 9.1 ± 3.1 | 0.60 |
| Hospital Length of Stay (post-transplant) (mean ± SD) | 24.3 ± 30.3 | 20.5 ± 13.2 | 0.64 |
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© 2021 Published by Elsevier Inc.
