In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 8 ( 2023-8-1), p. e0289177-
Abstract:
Patient outcomes are influenced by many confounding factors peri-operatively, including the type of surgery, anaesthesia, transfusion, and immune competence. We have previously demonstrated ( in-vitro ) that compared to allogeneic blood transfusion (ABT), intraoperative cell salvage (ICS) improves immune competence. The peri-operative immune response is complex. Altered or impaired immune responses may predispose patients to develop adverse outcomes (i.e., post-operative wound infection, pneumonia, urinary tract infection etc.) Surgical patients may develop infection, even without the confirmed presence of a definite microbiological pathogen. With all these factors in mind it is important to consider changes in immune cell numbers (and sub-populations) and functional capacity during peri-operative transfusion. Methods In this TRIMICS-Cell (Transfusion Related Immune Modulation and Intraoperative Cell Salvage-Cell numbers) study (n = 17, October 2018-November 2019) we prioritized and analysed peri-operative changes in the number and proportions of immune cell populations and sub-populations (B cells (CD20 + ), NK (natural killer) cells (CD56 + ), monocytes (CD14 + ), T cells (total CD3 + and sub-populations: T helper cells (CD4 + ), cytotoxic T cells (CD8 + ), effector T cells (CD4 + CD127 + ), activated effector T cells (CD4 + CD25 + CD127 + ) and regulatory T cells (CD4 + CD25 + CD127 - )), plasmacytoid dendritic cells (pDC; Lineage - , HLA-DR + , CD11c - , CD123 + ), classical dendritic cell (cDC) (Lineage - , HLA-DR + , CD11c + ), and cDC activation (Lineage - , HLA-DR + , CD11c + ), co-stimulatory/adhesion molecules and pDC (CD9 + , CD38 + , CD80 + , CD83 + , CD86 + , CD123 + ). Firstly we analysed the whole cohort of study patients and secondly according to the relevant transfusion modality (i.e., three study groups: those who received no transfusion, received ICS only (ICS), or both ICS and allogeneic packed red blood cells (pRBC) (ICS & RBC)), during major orthopaedic surgery. Results For the whole study cohort (all patients), changes in immune cell populations were significant: leucocytes and specifically neutrophils increased post-operatively, returning towards pre-operative numbers by 48h post-operatively (48h), and lymphocytes reduced post-operatively returning to pre-operative numbers by 48h. When considering transfusion modalities, there were no significant peri-operative changes in the no transfusion group for all immune cell populations studied (cell numbers and proportions (%)). Significant changes in cell population numbers (i.e., leucocytes, neutrophils and lymphocytes) were identified in both transfused groups (ICS and ICS & RBC). Considering all patients, changes in immune cell sub-populations (NK cells, monocytes, B cells, T cells and DCs) and functional characteristics (e.g., co-stimulation markers, adhesion, activation, and regulation) were significant peri-operatively and when considering transfusion modalities. Interestingly DC numbers and functional capacity were specifically altered following ICS compared to ICS & RBC and pDCs were relatively preserved post-operatively following ICS. Conclusion A transient peri-operative alteration with recovery towards pre-operative numbers by 48h post-surgery was demonstrated for many immune cell populations and sub-populations throughout. Immune cell sub-populations and functional characteristics were similar peri-operatively in those who received no transfusion but changed significantly following ICS and ICS & RBC. Interesting changes that require future study are a post-operative monocyte increase in the ICS & RBC group, changes in cDC considering transfusion modalities, and possibly preserved pDC numbers post-operatively following ICS. Future studies to assess changes in immune cell sub-populations, especially during peri-operative transfusion, while considering post-operative adverse outcomes, is recommended.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0289177
DOI:
10.1371/journal.pone.0289177.g001
DOI:
10.1371/journal.pone.0289177.g002
DOI:
10.1371/journal.pone.0289177.g003
DOI:
10.1371/journal.pone.0289177.g004
DOI:
10.1371/journal.pone.0289177.g005
DOI:
10.1371/journal.pone.0289177.t001
DOI:
10.1371/journal.pone.0289177.s001
DOI:
10.1371/journal.pone.0289177.s002
DOI:
10.1371/journal.pone.0289177.r001
DOI:
10.1371/journal.pone.0289177.r002
DOI:
10.1371/journal.pone.0289177.r003
DOI:
10.1371/journal.pone.0289177.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
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