JOURNAL ARTICLE

Clinical Effects of CD34 + Cell Therapy in Advanced Chronic Heart Failure Patients Listed for Heart Transplantation

G Poglajen, S Frljak, G Zemljič, R Okrajšek, A Cerar, M Šebeštjen, V Andročec, B Vrtovec
Journal of Heart and Lung Transplantation 2020, 39 (4S): S238
32465164

PURPOSE: Data on cell therapy in heart failure patients listed for heart transplantation (HTX) are lacking. We sought to investigate the clinical effects of CD34+ cell therapy in this patient cohort.

METHODS: In a single-center retrospective study we analysed data of all patients listed for heart transplantation between 2007 and 2017. Pediatric patients (<18 years), patients with congenital heart disease, mechanical circulatory support, and patients awaiting multi-organ transplantation were excluded. Of 372 patients included, 33 patients (Group A) received CD34+ cell therapy, and 339 (Group B) received optimal medical management. Patients were followed for 1 year; the primary end-point was the rate of delisting from HTX elective waiting list.

RESULTS: At the time of HTX listing the two groups did not differ in age (56±7 years in Group A vs. 54±10 years in Group B, P=0.24), gender (male: 100% vs. 80%, P=0.12), heart failure etiology (ishemic; 44% vs. 39%; P=0.55), history of hypertension (61% vs. 59%; P=0.99), renal dysfunction (33% vs. 23%, P=0.46) or diabetes (26% vs 24%, P=0.80). Left ventricular ejection fraction (LVEF: 22±3% vs. 24±4%, P=0.15) and NT-proBNP levels (3524±3821 pg/mL vs. 4048±3482 pg/mL, P=0.64) were also not different between the two groups. Within 1 year after HTX listing patients in both groups did not differ in rates of HTX (48% in Group A vs. 50% in Group B, P=0.88), LVAD implantation (0% in Group A vs. 4% in Group B, P=0.25), or total mortality (3% vs. 10%; p=0.16). However, in Group A, 24% of patients were delisted due to clinical improvement; compared to only 9% of patients in Group B (P=0.005). At the time of HTX listing, the delisted patients displayed similar clinical characteristics than the remaining cohort (LVEF: 22±2% in the delisted vs. 23±4% in the remaining cohort, P=0.67; NT-proBNP: 2822±1198 pg/mL vs. 3983±3927, P=0.45, ishemic heart failure etiology: 43% vs. 39%, P=0.77, history of hypertension: 61% vs. 58%; P=0.82; renal dysfunction: 31% vs. 25%, P=0.44 or diabetes: 20% vs 27%, P=0.52). On multivariate analysis, cell therapy was an independent correlate of delisting (P=0.002).

CONCLUSION: CD 34+ cell therapy appears to be associated with beneficial clinical outcomes and increased rates of delisting in advanced heart failure patients awaiting heart transplantation.

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