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The objective of this study was to look at the early outcomes of heart transplantation utilising the Sherpa-Pak storage and transport system and to compare this with icebox cold storage and transport. Prospectively collected single transplant centre data collected between April 2018 and March 2022 included 20 patients transplanted using the Sherpa-Pak and 54 using the conventional icebox. Endomyocardial biopsies were obtained 2 weekly for the first 3 months, monthly until 6 months and then at 3-monthly until 12 months with the ISHLT grading system used to evaluate Acute Cellular Rejection (ACR). Transthoracic ECHO data was analysed at 3 months and 1-year timepoints. Postoperative outcome data was analysed using GraphPad Prism v8 software using the Chi squared test for categorical and the Mann- Whitney U test for continuous variables. Kaplan Meier survival plots were used to compare the survival between the two groups. There were no statistically significant differences in demographic data. A significant reduction in the requirement for the use of ECMO for severe PGD (35.2% vs.10.0%, p=0.04), in respiratory complications (61.1% vs 10.0%, p=0.0001) and infectious complications (57.4% vs. 10.0%, p=0.0002) was seen in the transplant recipients utilising the Sherpa-Pak system. There was no statistically significant difference in ICU length of stay between the Sherpa-Pak and Icebox groups (14.1±12.6 vs 19.3±16.0, p=0.19); or total length of hospital stay (30.6±16.6 vs 35.6±20.4, p=0.32). A significantly lower occurrence of ACR was observed at 2 months and 12 months in the Sherpa group (both p=0.02). A significantly greater proportion of patients in the icebox group had LV dysfunction at 3 months (p=0.0004) and RV dysfunction (p=0.053 and p=0.002 at 3 and 12 months) compared to the Sherpa group with all Sherpa patients displaying normal function at these time point. More patients in the Sherpa group had normal LV wall thickness, with significantly greater incidence of concentric LVH reduced longitudinal function, or regional wall motion abnormality in the non-Sherpa group (p=0.01 and p=0.03 for 3 and 12 months). The use of the Sherpa-Pak system has clear clinically relevant benefits over conventional methods. [ABSTRACT FROM AUTHOR]