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Changes in lymphocyte subsets after cardiac surgery in children
Pirmin Habermehl1, Markus Knuf, Christof Kampmann
1Department of Paediatrics, University of Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany. pirmin_h@kinder.klinik.uni-mainz.de
Insights
Cardiac surgery with cardiopulmonary bypass (CPB) alters immune cells in children. Natural killer cells increase, while T-cells decrease, potentially impacting infection risk post-surgery.
Area of Science:
- Immunology
- Pediatric Cardiac Surgery
Background:
- Children undergoing cardiopulmonary bypass (CPB) face heightened infection risks.
- Immune system impairment may lead to complications like capillary leaks and autoimmune reactions.
Purpose of the Study:
- To investigate the impact of cardiac surgery with CPB on the immune system of infants and young children.
- To analyze changes in circulating lymphocyte subpopulations during and after CPB.
Main Methods:
- Prospective study of 21 infants and young children undergoing cardiac surgery for congenital heart disease.
- Analysis of lymphocyte subpopulations, including T-cells, natural killer cells, and activation/adhesion markers.
- Statistical analysis of pre- and post-operative immune cell counts (P<0.05).
Main Results:
- Leukocyte counts increased 6 hours post-surgery, driven by neutrophils.
- Absolute T-cell and T-helper cell numbers decreased within 24 hours after CPB.
- Proportions of gammadelta T-cells and natural killer cells increased during CPB, while activation and adhesion markers decreased post-CPB.
Conclusions:
- Cardiac surgery with CPB leads to increased natural killer cells and decreased T-cells in children.
- This immune shift is likely due to T-cell extravasation or adhesion.
- Findings are discussed in relation to the increased risk of infection following CPB.
Unlabelled:
Children undergoing cardiopulmonary bypass (CPB) operations have an increased risk of developing severe infections. Impairment of the immune system may contribute to the development of sequelae such as capillary leaks, pulmonary dysfunction and auto-immune reactions. The objective of this study was to investigate the impact of cardiac surgery with CPB on the immune system of infants and young children. We conducted a prospective study to investigate the changes in circulating lymphocyte subpopulations in a sample of 21 consecutive infants and young children undergoing cardiac surgery for congenital heart disease. The following statistically significant ( P<0.05) results were obtained: leucocyte counts rose 6 h after surgery due to the increase in neutrophils. Absolute T-cell number and absolute T-helper cell number decreased within 24 h after CPB. The proportion of T-cells expressing the T-cell receptor gammadelta as well as natural killer cells increased during CPB. In contrast, the proportion of T-cells expressing activation markers (CD25, CD45R0) decreased within 24 h after CPB, as did the number of cells expressing adhesion molecules (CD11b and ICAM).
Conclusion:
during cardiac surgery with cardiopulmonary bypass, absolute natural killer cell counts increase while T-cells decrease, presumably due to an extravasation or adhesion of activated T-cells. The relevance of this finding regarding the risk of infection is discussed.
