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Immunosuppression following surgical and traumatic injury

  • Review Article
  • Published: 26 August 2010
  • Volume 40, pages 793–808, (2010)
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Surgery Today Aims and scope Submit manuscript
Immunosuppression following surgical and traumatic injury
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  • Fumio Kimura1,
  • Hiroaki Shimizu1,
  • Hiroyuki Yoshidome1,
  • Masayuki Ohtsuka1 &
  • …
  • Masaru Miyazaki1 

  • 1702 Accesses

  • 151 Citations

  • Explore all metrics

Abstract

Severe sepsis and organ failure are still the major causes of postoperative morbidity and mortality after major hepatobiliary pancreatic surgery. Despite recent progress in understanding the immune conditions of abdominal sepsis, the postoperative incidence of septic complications after major visceral surgery remains high. This review focuses on the clinical and immunological parameters that determine the risk of the development and lethal outcome of postoperative septic complication following major surgery and trauma. A review of the literature indicates that surgical and traumatic injury profoundly affects the innate and adaptive immune responses, and that a marked suppression in cell-mediated immunity following an excessive inflammatory response appears to be responsible for the increased susceptibility to subsequent sepsis. The innate and adaptive immune responses are initiated and modulated by pathogen-associated molecular-pattern molecules and by damage-associated molecular-pattern molecules through the pattern-recognition receptors. Suppression of cell-mediated immunity may be caused by multifaceted cytokine/inhibitor profiles in the circulation and other compartments of the host, excessive activation and dysregulated recruitment of polymorphonuclear neutrophils, induction of alternatively activated or regulatory macrophages that have anti-inflammatory properties, a shift in the T-helper (Th)1/Th2 balance toward Th2, appearance of regulatory T cells, which are potent suppressors of the innate and adaptive immune system, and lymphocyte apoptosis in patients with sepsis. Recent basic and clinical studies have elucidated the functional effects of surgical and traumatic injury on the immune system. The research studies of interest may in future aid in the selection of appropriate therapeutic protocols.

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Authors and Affiliations

  1. Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Fumio Kimura, Hiroaki Shimizu, Hiroyuki Yoshidome, Masayuki Ohtsuka & Masaru Miyazaki

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Kimura, F., Shimizu, H., Yoshidome, H. et al. Immunosuppression following surgical and traumatic injury. Surg Today 40, 793–808 (2010). https://doi.org/10.1007/s00595-010-4323-z

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  • Received: 19 August 2009

  • Accepted: 01 March 2010

  • Published: 26 August 2010

  • Issue Date: September 2010

  • DOI: https://doi.org/10.1007/s00595-010-4323-z

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Key words

  • Surgery
  • Trauma
  • Sepsis
  • Organ failure
  • Pattern-recognition receptors
  • Polymorphonuclear neutrophils
  • Monocytes/macrophages
  • T lymphocytes
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