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A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System.

Publication ,  Journal Article
Shudo, Y; Leacche, M; Copeland, H; Silvestry, S; Pham, SM; Molina, E; Schroder, JN; Sciortino, CM; Jacobs, JP; Kawabori, M; Meyer, DM ...
Published in: ASAIO J
November 1, 2023

Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation. The Paragonix SherpaPak Cardiac Transport System (SCTS) is a controlled hypothermic technology clinically used since 2018. Real-world evidence on clinical benefits of SCTS compared to conventional ice cold storage (ICS) was evaluated. Between October 2015 and January 2022, 569 US adults receiving donor hearts preserved and transported either in SCTS (n = 255) or ICS (n = 314) were analyzed from the Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN-Heart) registry. Propensity matching and a subgroup analysis of >240 minutes ischemic time were performed to evaluate comparative outcomes. Overall, the SCTS cohort had significantly lower rates of severe primary graft dysfunction (PGD) ( p = 0.03). When propensity matched, SCTS had improving 1-year survival ( p = 0.10), significantly lower rates of severe PGD ( p = 0.011), and lower overall post-transplant MCS utilization ( p = 0.098). For patients with ischemic times >4 hours, the SCTS cohort had reduced post-transplant MCS utilization ( p = 0.01), reduced incidence of severe PGD ( p = 0.005), and improved 30-day survival ( p = 0.02). A multivariate analysis of independent risk factors revealed that compared to SCTS, use of ice results in a 3.4-fold greater chance of severe PGD ( p = 0.014). Utilization of SCTS is associated with a trend toward increased post-transplant survival and significantly lower severe PGD and MCS utilization. These findings fundamentally challenge the decades-long status quo of transporting donor hearts using ice.

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Published In

ASAIO J

DOI

EISSN

1538-943X

Publication Date

November 1, 2023

Volume

69

Issue

11

Start / End Page

993 / 1000

Location

United States

Related Subject Headings

  • Tissue Donors
  • Retrospective Studies
  • Incidence
  • Ice
  • Humans
  • Heart Transplantation
  • Heart
  • Biomedical Engineering
  • Adult
  • 4003 Biomedical engineering
 

Citation

APA
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Shudo, Y., Leacche, M., Copeland, H., Silvestry, S., Pham, S. M., Molina, E., … D’Alessandro, D. A. (2023). A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System. ASAIO J, 69(11), 993–1000. https://doi.org/10.1097/MAT.0000000000002036
Shudo, Yasuhiro, Marzia Leacche, Hannah Copeland, Scott Silvestry, Si M. Pham, Ezequiel Molina, Jacob N. Schroder, et al. “A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System.ASAIO J 69, no. 11 (November 1, 2023): 993–1000. https://doi.org/10.1097/MAT.0000000000002036.
Shudo Y, Leacche M, Copeland H, Silvestry S, Pham SM, Molina E, et al. A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System. ASAIO J. 2023 Nov 1;69(11):993–1000.
Shudo, Yasuhiro, et al. “A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System.ASAIO J, vol. 69, no. 11, Nov. 2023, pp. 993–1000. Pubmed, doi:10.1097/MAT.0000000000002036.
Shudo Y, Leacche M, Copeland H, Silvestry S, Pham SM, Molina E, Schroder JN, Sciortino CM, Jacobs JP, Kawabori M, Meyer DM, Zuckermann A, D’Alessandro DA. A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System. ASAIO J. 2023 Nov 1;69(11):993–1000.

Published In

ASAIO J

DOI

EISSN

1538-943X

Publication Date

November 1, 2023

Volume

69

Issue

11

Start / End Page

993 / 1000

Location

United States

Related Subject Headings

  • Tissue Donors
  • Retrospective Studies
  • Incidence
  • Ice
  • Humans
  • Heart Transplantation
  • Heart
  • Biomedical Engineering
  • Adult
  • 4003 Biomedical engineering