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Adaptive immunity is severely impaired by open-heart surgery
Tetsuro Sano1, Shigeki Morita, Ryuji Tominaga
1Division of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Objective:
The influence of open-heart surgery on antigen-specific immunity, also called adaptive immunity, remains to be clarified. We explored the effects of open-heart surgery on adaptive immunity.
Methods:
In 8 consecutive adult patients undergoing elective cardiac surgery with cardiopulmonary bypass, we measured the T cell-response to purified protein derivative (PPD) antigen perioperatively. We separately measured the proliferation of T cells and the antigen presentation of antigen-presenting cells (APCs) using a cross-reaction system.
Results:
T cell response to PPD antigen was severely impaired by open-heart surgery. Compared to preoperative values, T cell response to PPD antigen fell to 5.7 +/- 4.4% immediately after surgery, 4.5 +/- 3.2% on postoperative day (POD) 1, to 22.4 +/- 24.6% on POD 3 and to 50.1 +/- 34.3% on POD 7. T cell proliferation on POD1 decreased to 29 +/- 26%. APC antigen-presentation on POD 1 also decreased to 31 +/- 36%.
Conclusions:
Open-heart surgery impaired both T cell proliferation and the antigen-presentation. Such synergistic impairment severely impaired adaptive immunity. This impairment was both severer and longer than we anticipated based on previous studies using the response of T cells to lectin as a marker of cell-mediated immunity.