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Dysfunction of alveolar macrophages after cardiac surgery and postoperative pneumonia?--An observational study

Katharina Chalk, Christian Meisel, Claudia Spies

    Critical Care (London, England)
    |December 11, 2013
    PubMed
    Abstract

    Insights

    Cardiac surgery impairs lung immune cells, increasing pneumonia risk. Reduced HLA-DR and TLR expression on alveolar macrophages correlate with developing postoperative pneumonia.

    Area of Science:

    • Immunology
    • Pulmonology
    • Cardiothoracic Surgery

    Background:

    • Patients undergoing cardiac surgery face a heightened risk of postoperative pneumonia.
    • Pulmonary immune dysfunction is a potential contributing factor to this risk.
    • Alveolar macrophages (AMs) play a crucial role in lung immunity.

    Purpose of the Study:

    • To investigate changes in surface molecules on alveolar macrophages (AMs) after cardiac surgery.
    • To correlate these immune marker modulations with the development of postoperative pneumonia.

    Main Methods:

    • Observational study of 33 patients undergoing elective coronary bypass grafting surgery.
    • Collection of blood and alveolar lavage fluid pre- and post-cardiac surgery.
    • Assessment of Human Leukocyte Antigen-DR (HLA-DR) and Toll-Like Receptors (TLR) 2/4 expression on monocytes and AMs via flow cytometry.
    • Pneumonia diagnosis based on CDC criteria.

    Main Results:

    • Significant alterations in phenotypic and functional immune markers on AMs were observed post-cardiac surgery.
    • HLA-DR expression on monocytes and AMs decreased by approximately 30% in all patients.
    • Patients who developed pneumonia showed a trend towards greater reduction in HLA-DR and TLR4 expression on AMs.
    • Lower baseline TLR2 expression on AMs was noted in patients who later developed pneumonia.

    Conclusions:

    • This study demonstrates early impairment of lung cellular immune response following cardiac surgery.
    • Findings suggest a link between cell-mediated immunosuppression and the development of postoperative pneumonia.
    • Understanding these immune changes can inform strategies to prevent pneumonia in cardiac surgery patients.

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