Graft failure during the first few days posttransplantation remains one of the main unresolved complications. The objective of this study was to evaluate the influence of Celsior preservation solution on the incidence of early graft failure in high-risk cardiac transplant recipients. A retrospective study was carried out evaluating the cardiac transplants in 179 heart recipients. The patients were divided into 2 groups: (1) Celsior preservation solution (n = 37), and (2) Control solution (n = 142). To evaluate the efficacy of the Celsior solution, a subgroup of transplants from older donors or with ischemia times greater than 4 hours was compared with the other cases. The incidence of early graft failure was lower among the Celsior subgroups with longer ischemia times or of older donors compared with the control groups. We conclude that preservation with Celsior solution in cardiac transplantation is safe and effective. It even has advantages to reduce early graft failure compared with conventional solutions, a benefit that may be more evident in subgroups at high risk for myocardial dysfunction.