Monitoring of the cellular immune system in patients with biventricular assist devices awaiting cardiac transplantation

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Abstract
Lack of objective parameters to predict the clinical course and outcome are a major problem in managing the patients selected for BVAD‐support as a bridge to heart transplantation. This study was intended to assess whether cellular immune parameters have a predictive value for the clinical result of VAD‐support. Various cellular immune markers were monitored by multiparameter cytofluorometry in 30 patients who received a VAD system (Berlin Heart). We did not find significant differences in preoperative values of immune parameters between groups of survivors (n= 14) and non‐survivors (n= 16). All 9 patients who died of septic multiple organ failure (MOF) had shown increased levels of T‐cell activation (CD 71, CD 25, HLA‐DR) as well as leukocytosis and 7 patients who died of noninfectious complications (mostly hemorrhage or cerebral complications) had exhibited T‐lymphopenia. Seven of 9 patients who died of septic MOF had extremely decreased levels of HLA‐DR+ monocytes (in vitro results of restitution experiments call for new therapeutic strategies to improve the survival of VAD‐patients.