title: Immune perturbations in patients along the perioperative period: alterations in cell surface markers and leukocyte subtypes before and after surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Bartal
authors.forename: Rivka
authors.initials: R
authors.lastname: Melamed
authors.forename: Keren
authors.initials: K
authors.lastname: Greenfeld
authors.forename: Shir
authors.initials: S
authors.lastname: Atzil
authors.forename: Ariella
authors.initials: A
authors.lastname: Glasner
authors.forename: Vered
authors.initials: V
authors.lastname: Domankevich
authors.forename: Ranit
authors.initials: R
authors.lastname: Naor
authors.forename: Benzion
authors.initials: B
authors.lastname: Beilin
authors.forename: Israel Zeev
authors.initials: IZ
authors.lastname: Yardeni
authors.forename: Shamgar
authors.initials: S
authors.lastname: Ben-Eliyahu
mesh_terms: D000954:Antigens, Surface / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis*; D018845:CD11 Antigens / Q000097:blood; D005434:Flow Cytometry; D006098:Granulocytes / Q000502:physiology; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007958:Leukocyte Count; D007962:Leukocytes / Q000145:classification* / Q000276:immunology*; D008214:Lymphocytes / Q000502:physiology; D009000:Monocytes / Q000502:physiology; D011184:Postoperative Period; D057234:Preoperative Period; D013514:Surgical Procedures, Operative
chemical_list: D000954:Antigens, Surface; D015415:Biomarkers; D018845:CD11 Antigens; D006684:HLA-DR Antigens; D006854:Hydrocortisone