title: Immunologic complications of long-term implantation of a total artificial heart.
abstract: Bacterial infections are a significant complication of long-term total artificial heart implantation. We evaluated the functional capabilities of host defense mechanisms in two patients sustained long-term by a total artificial heart. Although serum complement and polymorphonuclear leukocyte function remained intact, both patients became B and T lymphopenic and there was an initial decrease in the ratio of helper/inducer to suppressor/cytotoxic cells. Histologic examination of their lymphoidal tissue at autopsy further revealed reduced numbers of germinal centers and atrophy of the T lymphocyte-dependent areas. In addition, the reticuloendothelial system was engorged with degenerate erythrocytes. We hypothesize that blockade of the reticuloendothelial system was induced by multiple blood transfusions necessitated by device-associated hemolysis and coagulopathy. This blockade may have led to a progressive loss of content of the antigen-specific lymphoidal elements and, perhaps, to a reduced ability to ingest microbe-antibody complexes.
authors.affiliation: Division of Nephrology, School of Medicine, University of Louisville, Kentucky 40292.
authors.forename: S R
authors.initials: SR
authors.lastname: Wellhausen
authors.forename: R A
authors.initials: RA
authors.lastname: Ward
authors.forename: G S
authors.initials: GS
authors.lastname: Johnson
authors.forename: W C
authors.initials: WC
authors.lastname: DeVries
mesh_terms: D001424:Bacterial Infections / Q000209:etiology / Q000276:immunology; D003167:Complement Activation; D006354:Heart, Artificial / Q000009:adverse effects*; D006801:Humans; D007113:Immunity, Innate; D007958:Leukocyte Count; D007970:Leukopenia / Q000209:etiology / Q000276:immunology; D008198:Lymph Nodes / Q000473:pathology; D009504:Neutrophils; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology*; D013601:T-Lymphocytes / Q000145:classification / Q000473:pathology; D013997:Time Factors