Immune perturbations in patients along the perioperative period: alterations in cell surface markers and leukocyte subtypes before and after surgery

Brain Behav Immun. 2010 Mar;24(3):376-86. doi: 10.1016/j.bbi.2009.02.010. Epub 2009 Feb 28.


Background: Surgery renders patients susceptible to life-threatening complications, including infections, multiple organ failure, and presumably cancer metastases. Surgery-induced immune perturbations were suggested to contribute to such deleterious effects, but also to facilitate post-injury healing. Preoperative psychological and physiological stress responses may contribute to these immune perturbations, and could thus jeopardize patients even before surgery. The current study assessed the effects of various operations on an array of immune indices during the perioperative period. To qualify immune changes before surgery, patients' immune status was also compared to that of healthy controls.

Methods: A total of 81 subjects (operated patients and healthy controls) provided up to five daily blood samples during the perioperative period, for assessment of leukocyte subtypes (granulocytes, monocytes, Tc, Th, NK, NKT, CD4+CD25+, CD8(bright)CD4(dim), and B cells) and their surface markers (HLA-DR and LFA-1).

Results: Even before surgery patients displayed immune perturbations, including reduced lymphocyte HLA-DR expression and increased monocyte LFA-1 expression. Following surgery, we recorded a reduction in lymphocyte numbers that was subtype specific, increased granulocyte numbers, and reduced expression of HLA-DR by lymphocytes and monocytes. Finally, no significant associations were found between alteration in leukocyte numbers and cell surface markers (although these indices showed high correlations with other variables), implying differential mediating mechanisms.

Conclusion: Several immune alterations are manifested prior to surgery, and contribute to the marked postoperative changes, which are commonly interpreted as immune suppression. We discuss the possible adaptive and maladaptive nature of these perturbations in the context of natural injury, stress, and surgery.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antigens, Surface / analysis*
  • Biomarkers / analysis*
  • CD11 Antigens / blood
  • Flow Cytometry
  • Granulocytes / physiology
  • HLA-DR Antigens / blood
  • Humans
  • Hydrocortisone / blood
  • Leukocyte Count
  • Leukocytes / classification*
  • Leukocytes / immunology*
  • Lymphocytes / physiology
  • Monocytes / physiology
  • Postoperative Period*
  • Preoperative Period*
  • Surgical Procedures, Operative


  • Antigens, Surface
  • Biomarkers
  • CD11 Antigens
  • HLA-DR Antigens
  • Hydrocortisone