Cellular and humoral immune response to open heart surgery in children is modulated by methylprednisolone

  • Mr Dr Jozsef Bocsi, Pediatric Cardiology, Cardiac Centre Leipzig, University Leipzig,, Germany
  • Ms Dr Marie –Christin Haenzka, Pediatric Cardiology, Cardiac Centre Leipzig, University Leipzig,, Germany
  • Mr Dr Pavel Osmancik, Cardiocenter, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic, Czech Republic
  • Mr Dr Joerg Hambsch, Pediatric Cardiology, Cardiac Centre Leipzig, University Leipzig,, Germany
  • Mr Prof Dr Ulrich Sack, Institute for Clinical Immunology, IKIT, University Leipzig,, Germany
  • Mr Dr Winfried Bellinghausen, Anaesthesiology, Cardiac Centre Leipzig, University Leipzig,, Germany
  • Mr Prof Dr Jan Janousek, Heart Center Leipzig, Germany
  • Mr Prof Dr Attila Tarnok, Pediatric Cardiology, Cardiac Centre Leipzig, University Leipzig,, Germany

    • Postoperative effusions, edema and capillary leak syndrome in children after cardiac surgery with cardiopulmonary bypass (CPB) constitute considerable clinical problems. In order to reduce overshooting immune response glucocorticoids are administered pre- and perioperatively. In a retrospective study we investigated the modulation of humoral and cellular immune response by methylprednisolone (MP).

    Children undergoing cardiac surgery (mostly septum defect corrections) without (MP-, n=10) and with MP administration before CPB (MP+, n=23, dose: 5-20mg/kg body-weight) were enrolled. Blood was obtained 24h preoperatively, after anesthesia, CPB begin, CPB end, 4h, 24h, 48h after surgery, at discharge and at out-patient follow-up (9.1+7.0 month after surgery). Serum analysis, clinical chemistry and flow cytometry were performed to determine the degree of activation of various leukocyte subpopulations.

    The patients follow-up was uneventful. Effusion volume, intensive care unit and hospital days were similar with and without MP. Release of proinflammatory cytokines (IL-6, IL8) was reduced and of anti-inflammatory cytokines (IL-10) upregulated by MP. Significant peri- und postoperative increase of circulating neutrophils and monocytes was detected in both groups. However, infiltration of monocytes was delayed with MP. LFA-1 and Mac-1 expression were similar for MP+ and MP-. T-lymphocyte count decreased and the CD4+/CD8+ ratio was lower with MP+. B-lymphocytes count increased significantly in the MP+ but remained constant in the MP- group.

    MP treatment decreased the proinflammatory effect of CPB-surgery and induced antiinflammatory effect on the cellular and humoral level, but without obvious clinical advantages during surgery and at outcome.

    Support:
    German Heart Foundation;
    MSM-0021620817-Charles University Prague, Czech Republic(P.O.)