Complications of Immunosuppression in Pediatric Surgery
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An intact immune system is required to distinguish between self and nonself, as well as between dangerous and non-dangerous signals to maintain a homeostasis of regenerating tissues and to avoid invasion of pathogens into an organism. Any immunodeficiency disorder, whether primary (inborn) or secondary immunodeficiency, due to immunosuppressive or cytotoxic treatment, may therefore increase the risk of perioperative complications in pediatric surgery.
This chapter defines underlying conditions such as leukemias, solid tumors, autoimmune diseases, and inborn errors of immunity such as immunodeficiency syndromes as well as treatment modalities, e.g., cytotoxic chemotherapy, radiotherapy, hematopoietic stem cell transplantation, and pharmacological immunosuppression, that represent potential reasons for an increased risk of local, endoprosthetic, and systemic infections and wound healing complications in pediatric patients. The mechanism of action of most commonly used therapeutic agents in pediatric oncology and patients with autoimmune diseases like corticosteroids, chemotherapy, biologicals, small compounds, etc. and their potential adverse effects (e.g., immunosuppression, impairment of collagen synthesis, antiproliferative effects) on the perioperative course of children are described.
In conclusion, planning and scheduling of any surgical treatment in immunocompromised children and adolescents should include the analysis of absolute neutrophil counts; the concentration of immunoglobulin G, platelet counts, and plasmatic coagulation; and an assessment of the functional impairment of inflammation regulation and immunity conferred by pharmacological treatment. These facts then need to be put in the context of current scientific evidence and allow for a risk-minimizing multidisciplinary planning of surgery and supportive care.
KeywordsImmunodeficiency Immunosuppression Chemotherapy Complication Tumor surgery Pediatric surgery Radiotherapy Hematopoietic stem cell transplantation Wound dehiscence Wound infection Wound healing
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