Biological monitoring of immunological modifications in patients supported with left ventricular assist system

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We investigated a total of 30 patients with end-stage heart failure awaiting heart transplantation. Age ranged between 7 and 54, mean of 32.9. Twenty seven patients were male and 3 were female. Among them, 15 underwent the implantation of left ventricular assist system. Anti-T and B cell antibodies against pooled panel cells from Japanese population were measured in these patients. Serum IL-6 and IL-8 level were also examined. As the antibodies against HLA class-I are known to have close relations with post-transplant rejections, the changes of the anti-T antibodies and clinical courses were analyzed. Anti-T cell antibody level became positive in 4 of 15 patients (26.7%) with LVAS and 2 of 15 patients (13.3%) without LVAS. One of 2 patients without LVAS and with positive T cell Abs received heart transplantation successfully and underwent no significant rejection episodes. The other patients continued to have positive T cell Ab level for more than a year, therefore received immunosuppressive therapy with cyclophosphamide. His Ab level dropped significantly and awaiting heart transplantation. Two LUAS patients with positive T cell Abs experienced spontaneous decrease of Ab level. One patient, who also had spontaneous decrease of Ab level underwent heart transplantation. Although direct cross-match was negative, he experienced severe humoral rejection a week after the transplant. Plasma exchange and intense immunosuppressive therapy successfully control this rejection episode. Significant elevation, of the level of anti-donor spleen cell antibodies were detected. The other LVAS patient had a complicated course with persistent infectious complications and expired from infectious endocarditis. His anti-T cell Ab level, serum IL-6 and IL-8 level were persistently high, suggesting hyper-cytokinemia may play a role in enhancing a production of all-antibodies