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

Inbal Bartal, Rivka Melamed, Keren Greenfeld, Shir Atzil, Ariella Glasner, Vered Domankevich, Ranit Naor, Benzion Beilin, Israel Zeev Yardeni, Shamgar Ben-Eliyahu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


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+, CD8brightCD4dim, 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.

Original languageAmerican English
Pages (from-to)376-386
Number of pages11
JournalBrain, Behavior, and Immunity
Issue number3
StatePublished - Mar 2010
Externally publishedYes

Bibliographical note

Funding Information:
I. Bartal and S. Ben-Eliyahu were supported by NIH/NCI grant # CA73056. We thank the anonymous reviewers for their helpful comments.


  • Adaptive
  • Cell surface markers
  • Cellular immunity
  • Perioperative
  • Surgery


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