First clinical experience with the novel cold storage SherpaPak™ system for donor heart transportation

Dejan Radakovic, Seymur Karimli, Kiril Penov, Ina Schade, Khaled Hamouda, Constanze Bening, Rainer G Leyh, Ivan Aleksic, Dejan Radakovic, Seymur Karimli, Kiril Penov, Ina Schade, Khaled Hamouda, Constanze Bening, Rainer G Leyh, Ivan Aleksic

Abstract

Background: The current gold standard for donor heart preservation is a three-bag-technique and storage in a cooler filled with slush ice. This technique can cause freezing injury with protein denaturation. We report our early experience with a single-use disposable device (SherpaPak™, Paragonix Technologies, MA, USA) specifically designed for sterile permanent temperature-controlled transportation of donor hearts.

Methods: In this case control study with 2:1 matching we identified 21 patients after heart transplantation depending on type of organ transport (standard three-bag-technique vs. SherpaPak™). The outcome after donor heart storage in the SherpaPak™ was compared with donor heart transportation with the standard technique.

Results: Since July 2018 seven patients (5 males; mean age 50.3±13.2years) underwent heart transplantation with the SherpaPak™ system. Cold ischemic time was longer in the SherpaPak™ group (207.7±23.3 vs. 181.6±21.9, P=0.027). SherpaPak™ kept the organ temperature at 5.1±0.8 °C, with an average outside temperature of 21.4±3.6 °C. Among all 21 transplanted patients four developed fatal early graft failure (28.6% vs. 21.4%, P=0.432). Over the first hours we noticed no difference in hemodynamic parameters, CK-MB levels or vasoactive-inotropic score. During first follow-up we noticed slightly better right heart function in the SherpaPak™ group (TAPSE 17.83±2.71 vs. 14.52±2.61 mm, P=0.020). We identified no positive blood cultures in the SherpaPak™ group within the first 30 days after heart transplantation.

Conclusions: The SherpaPak™ provides a constant temperature during transportation with permanent monitoring, never dropping below 4 °C. Organs transported with this novel device showed a normal perioperative function.

Keywords: Heart transplantation; cold storage, organ transportation.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1827). The authors have no conflicts of interest to declare.

2020 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1
Figure 1
SherpaPak™ Transport System preparation: after explantation of the donor heart the heart connector with temperature probe is fixed to the aorta and the sterile inner organ canister is filled with cold cardioplegia (A). The donor heart is emerged in the preservation fluid (B). The inner organ canister is deaired with the preservation fluid filled up to the top of the container emerging the donor heart completely allowing homogenous hypothermic protection and reducing the risk of mechanical injury due to organ movement during transport (C) and placed in the outer canister. The closed rigid storage canister set can now safely be moved (D), and is locked in the insulated shipper filled with disposable cold packs with high latent cold storage in the 4–8 °C range (E).
Video 1
Video 1
SherpaPak™ Transport System preparation with donor heart during donor heart harvesting.
Figure 2
Figure 2
Organ temperature is maintained within a narrow range throughout the transport despite higher ambient temperature with the SherpaPak.

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