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Introduction:With increasing heart transplant (HTx) waitingtimes, improvement of bridge-to-transplant therapies is paramount. Previously we showed that immunoadsorbtion (IA) in patients with idiopathic dilated cardiomyopathy (IDCM) who tested positive for autoantibodies against β1-adrenoceptors (β1-AABs) is superior to standard medical therapy. Now we assessed the long-term efficacy of IA in HTx-candidates with IDCM trying to answer the following main questions:(1) What is the expected HTx-free survival probability after β1-AAB removal in IDCM patients with LVEF ≤30%?(2) What is the responder rate to IA therapy?(3) How relevant is the early post-IA reappearance-rate of β1-AABs and what is its impact on patients' outcome? (4) Has the selectivity of β1-AAB removal any impact on post-IA patients' outcome? Methods: Cardiac function and survival without HTx or ventricular assist device (VAD) implantation were evaluated in β1-AAB positive transplant candidates with severe IDCM (LVEF <30%) who underwent IA between 5/1995-8/2004 (follow-up: 5-14 years). Between 5/1995 and 8/2000 all patients underwent unspecific IA. Thereafter, between 8/2000 and 8/2004, both unspecific and specific IA was performed and patients were randomly selected for one of the two procedures. In these patients we looked for differences in efficacy between unselective (unspecific IA) and selective (specific IA) β1-AAB removal. Results: At 6 months after IA, the 127 IDCM patients who fulfilled the inclusion criteria showed significant LV diameter decrease from 73±8mm to 67±9mm and LVEF improvement from 23±5% to 29±8% (p<0.01). The prevalence of responders to IA was similar in patients with unselective and selective β1-AAB removal (78.4% and 75%, respectively) and there were also no differences in cardiac improvement between the 2 patient groups. HTx or VAD free survival was reached at 3 years and 5 years by 77.3% and 69.3% of patients with unspecific IA and by 95% and 89.1% of those with specific IA, respectively (p=0.0479). However, comparing the patients' outcome after unselective and selective β1-AAB removal for only those who receive IA during the same time period (between 8/2000 and 8/2004), the probability of survival appeared not significantly different (p=0.483). Comparing the group of patients with stable cardiac improvement for >5 years with the group of non-responders plus responders with recurrence of HF during the first 5 years after IA, we found that before IA there were no differences between the groups in either patients' age or in LV size and ejection fraction. Early reappearance of β1-AABs was shown in only 9 (7.9%) of the 127 patients, but appeared always associated with cardiac worsening. Conclusions: Although the probability of regaining normal cardiac function after IA is very low, in a high proportion of IDCM patients with severe LV dysfunction associated with evidence of serum ß1-AABs, both unspecific and specific IA therapy allows evident and long-term stable improvement of cardiac function. This provides not only an efficien...