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Capt Ramon Berguer, MD; Normita Bravo, MS, USAF; Mark Bowyer, MD; Craig Egan, MD; Tom Knolmayer, MD; David Ferrick, PhD

Arch Surg. 1999;134:540-544.

Background  Major surgery is known to suppress T-cell function; however, its differential effects on the production of helper T-cell type 1 (T_H1) and type 2 (T_H2) cytokines remains unknown.

Objective  To measure the production patterns of T_H1 (interleukin 2 [IL-2] and interferon ) and T_H2 (IL-4 and IL-10) cytokines following major surgery.

Design, Setting, and Patients  A cohort study of patients (both active and former members of the armed forces) at a military hospital.

Intervention  Aortic surgery or carotid endarterectomy and measurement of serum IL-6 levels by enzyme-linked immunosorbent assay.

Main Outcome Measures  Unstimulated and stimulated intracellular levels of IL-2, IL-4, IL-10, and interferon in CD4⁺, CD8⁺, and ⁺ T cells and serum IL-6 levels immediately before and for 2 days after aortic surgery or carotid endarterectomy.

Results  No unstimulated production of T_H1 or T_H2 cytokines was detected. Stimulated intracellular levels of IL-2 and interferon were significantly depressed during the postoperative period in all T-cell subsets in both patient groups. There were no postoperative increases in stimulated IL-4 or IL-10 levels.

Conclusion  Major surgery suppresses the potential responses of T_H1 cytokines without enhancing production of T_H2 cytokines.

From the Departments of Surgery (Dr Berguer) and Pathology, Microbiology, and Immunology (Dr Ferrick), University of California, Davis; Clinical Investigation Facility (Capt Bravo) and Surgical Flight (Drs Bowyer, Egan, and Knolmayer), David Grant Medical Center, Travis Air Force Base; Surgical Service, Department of Veterans Affairs, Northern California Health Care System, Martinez (Dr Berguer); and Rigel Inc, Sunnyvale (Dr Ferrick), Calif.

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