Purpose We aim to evaluate the clinical outcomes at 1-year follow-up of heart transplant recipients to assess the Paragonix SherpaPak Cardiac Transport System (SHRP) as compared to conventional methods (ICE). Methods The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN) study is a retrospective, multi-institutional registry including 11 US heart transplant centers at the time of this analysis. Each center enrolled both SHRP and historic ICE patients to serve as their own control. Results Between 10/2015-08/2021, 383 patients, 227 (59%) SHRP, 156 (41%) ICE were identified to meet analysis inclusion. Baseline characteristics of the two cohorts were largely similar with the exception in the SHRP cohort of more patients transplanted after the 2018 allocation change (96.5% v 55.8%, p<0.001), lower rates of implantable LVADs (35.2% v 55.1%, p<0.001), higher rates of pre -transplant temporary IABP (29.6% v 13.0%, p<0.001) and pre-transplant ECMO (17.2% v 7.8%, p=0.01), longer distance to donor organ (463 v 274 miles, p<0.001), longer ischemic time (217 v 195 min, p<0.001) compared to ICE respectively. The SHRP cohort showed a significant reduction in the incidence of severe PGD (5.3% v 13.0%, p=0.01) and a trend in reduction of newly placed ECMO post-transplant (8.8% v 14.7%, p=0.07). 30-day survival was 97.8% in SHRP v 95.5% in ICE (p=0.22). Follow-up at 1-year found a survival of 91.1% (112 of 123 subjects available for follow-up) in SHRP v 86.0% (111 of 129 subjects available for follow-up) in ICE (p=0.21) (Figure 1). Conclusion Despite a cohort with known risk factors including longer ischemic times and more acute support, the PGNX cohort shows significant reductions in severe PGD. 1-year survival was higher although it did not achieve statistical significance. The Paragonix SherpaPak Cardiac Transport System appears to have a positive effect on patient outcomes across multiple US centers in this analysis. We aim to evaluate the clinical outcomes at 1-year follow-up of heart transplant recipients to assess the Paragonix SherpaPak Cardiac Transport System (SHRP) as compared to conventional methods (ICE). The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN) study is a retrospective, multi-institutional registry including 11 US heart transplant centers at the time of this analysis. Each center enrolled both SHRP and historic ICE patients to serve as their own control. Between 10/2015-08/2021, 383 patients, 227 (59%) SHRP, 156 (41%) ICE were identified to meet analysis inclusion. Baseline characteristics of the two cohorts were largely similar with the exception in the SHRP cohort of more patients transplanted after the 2018 allocation change (96.5% v 55.8%, p<0.001), lower rates of implantable LVADs (35.2% v 55.1%, p<0.001), higher rates of pre -transplant temporary IABP (29.6% v 13.0%, p<0.001) and pre-transplant ECMO (17.2% v 7.8%, p=0.01), longer distance to donor organ (463 v 274 miles, p<0.001), longer ischemic time (217 v 195 min, p<0.001) compared to ICE respectively. The SHRP cohort showed a significant reduction in the incidence of severe PGD (5.3% v 13.0%, p=0.01) and a trend in reduction of newly placed ECMO post-transplant (8.8% v 14.7%, p=0.07). 30-day survival was 97.8% in SHRP v 95.5% in ICE (p=0.22). Follow-up at 1-year found a survival of 91.1% (112 of 123 subjects available for follow-up) in SHRP v 86.0% (111 of 129 subjects available for follow-up) in ICE (p=0.21) (Figure 1). Despite a cohort with known risk factors including longer ischemic times and more acute support, the PGNX cohort shows significant reductions in severe PGD. 1-year survival was higher although it did not achieve statistical significance. The Paragonix SherpaPak Cardiac Transport System appears to have a positive effect on patient outcomes across multiple US centers in this analysis.