Advanced Organ Preservation: The Paragonix SherpaPak Cardiac Transport System, Experience of a Cardiosurgical Centre

All articles of this category (opens in new window) Background: The secure and controlled preservation of donor organs during transport is a critical determinant of successful organ transplantation. While traditional methods employ simple ice-cooled containers, these offer limited control over temperature and environmental conditions. Advanced transport systems, such as the Paragonix SherpaPak (SP), provide, among other things, precise, continuously monitored temperature management, thereby mitigating the risk of temperature-induced organ damage. Methods: Between 2010 and 2025, 379 heart transplants were performed at our center. Since August 2024, the Paragonix SP has been used alongside static cold storage. This retrospective study analyzes the first 35 SP cases (SP-Group) regarding demographics, clinical data, outcomes, and complications, compared to hearts transported in standard ice-cooled boxes (SICB). Results: In cases utilizing the SP, the mean intra-transport temperature was recorded at 5.3°C, with a mean minimum of 4.6°C and a mean maximum of 6.0°C. The mean duration of cold ischemia for the SP-Group was 159.9 ± 29.1 minutes compared to 150.7 ± 45.7 in the SICB-Group ( p = 0.299). Patients in the SP-Group had noticeably worse baseline conditions, or showed a higher number of preexisting conditions, including CPR prior to transplantation (8.1% vs. 53% ( p = 0.039)), cardiogenic shock pretransplantation (8% vs. 52% ( p ≤ 0.001)) nicotine abuse (21% vs. 50%( p = 0.005)), diabetes (23% vs. 41% p = 0.005)), and pulmonary hypertension (8% vs. 27% ( p = 0.001)). Furthermore, a higher prevalence of infection prior to transplantation (13% vs. 33%, p = 0.052) and a need for dialysis (6% vs. 21% p = 0.002) were observed in the SP-Group. Additionally, the donor organs transplanted within the SherpaPak group presented with inferior baseline characteristics. The incidence of the donor’s drug abuse was significantly higher in the SP-Group compared to the SICB-Group (27% vs. 10%, p = 0.048). Despite these differences, transplant outcomes, including 30-day and 6-month survival, and postoperative complications such as rejection, early graft failure, and the need for ECMO, were comparable between the groups. Conclusion: Despite significantly poorer initial conditions in the recipients as well as in the donors, no difference in short-term outcome depending on preservation method could be observed. The findings may suggest that the SP system is a safe and effective method for organ preservation. The system may benefit recipients with high-risk profiles or marginal donor organs, even when facing extended cold ischemic durations. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany