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Influence of cardiac surgery on immune competence in children


To study whether immune competence as assessed by HLA-DR expression on monocytes and by ex vivo production of TNFα allows prediction of complications after cardiac surgery, and to analyze the influence of cardiac surgery on immune competence.


Forty patients aged 1 to 188 months undergoing cardiac surgery were enrolled. Whole blood was collected before, 1, 3, and 5 days after surgery. HLA-DR expression (expressed as antiboby binding capacity, Abc) was determined using a flow cytometric assay. TNFα production was assessed in the supernatant after whole blood stimulation with LPS (500 pg/ml; incubation: 4 h) with the Immulite (DPC Biermann GmbH). Severity of the operation and postop clinical condition were assessed by score.


Ten patients developed postop complications (group 1) and 30 not (group 2). Preop HLA-DR (32,000 Abc) was not significantly different between groups. In contrast, preop ex vivo production tended to be lower in group 1 than in group 2 (TNFα: 363 vs 628 pg/ml, P = 0.06). In both groups, HLA-DR significantly decreased on postop day 1 (10,000 Abc, P < 0.002 vs preop) and remained significantly lower than preop value up to postop day 5. Group 1 had significantly higher and persistent decrease of HLA-DR over the postop period than group 2. Severity of operation and clinical score 4 and 24 h postop negatively correlated with postop HLA-DR but not with ex vivo TNFα production.


Cardiac operations in children are associated with impairment of immune competence, which is more severe and persistent in patients with postop complications. Our results suggest that preop ex vivo TNFα production but not HLA-DR expression could be predictive for the development of postop complications. With this regard, additional study of TNFα gene polymorphism (locus 308) is expected to allow further preoperative risks stratification.

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Kunz, D., Schumacher, K., Germar, J. et al. Influence of cardiac surgery on immune competence in children. Crit Care 5 (Suppl 1), P077 (2001).

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