Correlation between anergy and a circulating immunosuppressive factor following major surgical trauma

Area of Science:

• Immunology
• Surgical Pathology

Background:

• Postoperative anergy, a suppressed cellular immune response, is a known complication.
• The presence of immunosuppressive factors in serum following surgery requires further investigation.

Purpose of the Study:

• To clarify the relationship between postoperative anergy and serum immunosuppressive activity.
• To identify the characteristics of immunosuppressive serum and its clinical implications.

Main Methods:

• Assessed delayed hypersensitivity via skin testing in 46 patients before and after surgery.
• Measured serum immunosuppressive activity by its effect on phytohemagglutinin (PHA)-stimulated lymphocytes.
• Fractionated immunosuppressive serum using chromatography and electrophoresis.

Main Results:

• A significant correlation (p < 0.001) was found between postoperative anergy and the presence of immunosuppressive serum.
• Major cardiovascular surgery led to anergy and immunosuppressive serum in a subset of patients, unlike minor surgery.
• Anergic patients exhibited higher postoperative infectious complications and longer hospitalizations (p < 0.05, p < 0.01).
• A specific polypeptide fraction was identified as the primary source of immunosuppressive activity in anergic patients' serum.

Conclusions:

• Major operative trauma induces a circulating immunosuppressive molecular species associated with anergy.
• This immunosuppression contributes to increased patient morbidity and prolonged hospitalization.
• Delayed hypersensitivity and immune function typically recover by postoperative day 28.