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

我们总共调查了30例等待心脏移植的终末期心力衰竭患者。年龄介乎7至54岁，平均32.9岁。男性27例，女性3例。其中，植入左心室辅助系统15例。在这些患者中检测了针对日本人群的混合面板细胞的抗t细胞和B细胞抗体。同时检测血清IL-6、IL-8水平。由于HLA - 1类抗体与移植后排斥反应密切相关，我们分析了抗t抗体的变化和临床病程。15例LVAS患者中4例（26.7%）抗t细胞抗体呈阳性，15例非LVAS患者中2例（13.3%）呈阳性。2例无LVAS且T细胞抗体阳性的患者中有1例成功接受了心脏移植，没有发生明显的排斥反应。其他患者T细胞Ab水平持续阳性超过一年，因此接受环磷酰胺免疫抑制治疗。Ab水平明显下降，等待心脏移植。2例T细胞抗体阳性的LUAS患者Ab水平自发下降。1例Ab水平自发性下降的患者行心脏移植手术。虽然直接交叉配型阴性，但移植一周后他出现了严重的体液排斥反应。血浆置换和强化免疫抑制治疗成功地控制了这种排斥反应。抗供体脾细胞抗体水平明显升高。另一名LVAS患者病程复杂，伴有持续的感染并发症，并因感染性心内膜炎而死亡。他的抗t细胞Ab水平、血清IL-6和IL-8水平持续高，提示高细胞素血症可能在促进所有抗体的产生中起作用

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