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

Abstract

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 ( 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 CD34+ cell therapy appears to be associated with beneficial clinical outcomes and increased rates of delisting in advanced heart failure patients awaiting heart transplantation.