2005 Abstracts: Disturbance of Cellular Immunity But Not Viral Reactivation Can Predict Outcome After Major Esophageal or Pancreatic Resections
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Disturbance of Cellular Immunity But Not Viral Reactivation Can Predict Outcome After Major Esophageal or Pancreatic Resections
Thomas Vogel, Rudite Vadonis, Norbert Senninger, Joerg Haier, University Hospital Muenster, Dept. General Surgery, Muenster, Germany, Germany
Problem: Septic complications are an important determinant of postop. outcome after major surgery. Malignant diseases and surgical trauma can influence immune responses and infectious defense. However, preop. risk stratification or early diagnostic are not routinely available, and therefore the onset of treatment is usually late. In this prospective study, patients who underwent major surgical resections for esophageal or pancreatic cancer were investigated for their cellular immunity pre- and postop. and the effects of disturbed immune functions on viral reactivation with respect to the prediction of septic complications.
Methods: 84 patients (22 esophageal, 21 pancreatic, 17 exploration, 19 healthy, 5 active sepsis) were included. Cellular immunity was determined preop. and at d1, d3, d5 postop. using FACS for lymphocytes (T-cells, T-Helper cells, T-Suppressor cells, B-cells, NK-cells), Monocytes, and HLA activation on these cells. Parallel viral antigens, viral DNA and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and mouth swabs. Absolute values and relative changes were compared with the postop. outcome (30 day morbidity). For statistical analyses Student's t-test and Chi²-test were used. P-values were accepted for p<0.05. Results: Initially (d1), sign. reductions after major surgery were found for T-lymphocyte populations (mostly T-Helper and T-Suppressor cells), monocytes and HLA expression independent from further outcome (p<0.05-0.005). Starting at d3 patients with complications showed a further decrease (p<0.05), whereas in the patients without complications cellular immunity started to recover. HLA-positive monocytes also remained sign. reduced in the first group (p<0.05). B-cells and NK-cells were not affected. This disturbed cellular immunity, however, did not result in sign. alterations of viral load. A postop. sign. reduction in anti-CMV titers (p<0.05) also remained suppressed in patients with septic complications. Discussion: The monitoring of cellular immunity demonstrated a sign. impaired capacity for its recovery in cancer patients with septic complications after major surgical resections. This disturbed immune function correlated with reduced anti-viral immunity but not with increased viral load. Analysis of T-Helper cells, T-Suppressor cells and monocytes including their HLA expression appears to be useful for early prediction of septic complication in these patients.
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