Abstract: Aim: This nationwide study evaluated the clinical impact that an early thymectomy, during congenital heart defect (CHD) surgery, had on the health of children and adolescents.
Methods: The subjects were patients aged 1-15 years who had undergone CHD surgery at the University Children's Hospital, Helsinki, where all CHD surgery in Finland is carried out, from 2006 to 2018. The parents or the cases and population-based controls, matched for sex, age and hospital district, completed electronic questionnaires. We excluded those with low birth weights or a known immunodeficiency. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for prespecified outcomes.
Results: We received responses relating to 260/450 (58%) cases and 1403/4500 (31%) controls and excluded 73 cases with persistent cardiac or respiratory complaints after surgery. The CHD group reported more recurrent hospitalisations due to infections (aOR 6.3, 95% CI 3.0-13) than the controls and more pneumonia episodes (aOR 3.5, 95% CI 2.1-5.6), asthma (aOR 2.5, 95% CI 1.5-4.1) and wheezing (aOR 2.1, 95% CI 1.5-2.9).
Conclusion: Hospitalisation due to infections, pneumonia, wheezing and asthma was more common in children after a thymectomy due to open-heart surgery than population-based controls, underlining the importance of immunological follow-ups.
(© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)
References: Fry AM, Jones LA, Kruisbeek AM, Matis LA. Thymic requirement for clonal deletion during T cell development. Science. 1989;246(4933):1044‐1046.
Hodes RJ, Sharrow SO, Solomon A. Failure of T cell receptor V beta negative selection in an athymic environment. Science. 1989;246(4933):1041‐1044.
Kizilcan M, Bilaloglu P, Tamac NI. Changes in normal thymus size during infancy: sonographic evaluation. Eur Radiol. 1995;5:55‐59.
Jokinen E, Mattila I. Synnynnäisten sydänvikojen ennuste on parantunut merkittävästi. Duodecim. 2020;136(6):673‐676. [In Finnish].
Raissadati A, Jokinen E, Sairanen H. Lasten sydänkirurgian myöhäistulokset. Duodecim. 2015;131(15):1324‐1325. [In Finnish].
van den Broek T, Delemarre EM, Janssen WJ, et al. Neonatal thymectomy reveals differentiation and plasticity within human naive T cells. J Clin Invest. 2016;126(3):1126‐1136.
Mancebo E, Clemente J, Sanchez J, et al. Longitudinal analysis of immune function in the first 3 years of life in thymectomized neonates during cardiac surgery. Clin Exp Immunol. 2008;154(3):375‐383.
Sauce D, Larsen M, Fastenackels S, et al. Evidence of premature immune aging in patients thymectomized during early childhood. J Clin Invest. 2009;119(10):3070‐3078.
Elder RW, George RP, McCabe NM, et al. Immunologic aging in adults with congenital heart disease: does infant sternotomy matter. Pediatr Cardiol. 2015;36(7):1411‐1416.
Roosen J, Ousterlinck W, Meyns B. Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance. Interact Cardiovasc Thorac Surg. 2015;20(1):101‐106.
Zlamy M, Almanzar G, Parson W, et al. Efforts of the human immune system to maintain the peripheral CD8+ T cell compartment after childhood thymectomy. Immun Ageing. 2016;13:3.
Eysteinsdottir JH, Freysdottir J, Haraldsson A, et al. The influence of partial or total thymectomy during open heart surgery in infants on the immune function later in life. Clin Exp Immunol. 2004;136(2):349‐355.
Kurobe H, Tominaga T, Sugano M, et al. Complete but not partial thymectomy in early infancy reduces T‐cell‐mediated immune response: three‐year tracing study after pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2013;145(3):656‐662.
Cao Q, Yin M, Zhou Y, Liu J, Sun K, Li B. Effect of thymectomy on cellular immune function. Front Biosci (Landmark ed). 2011;16(8):3036‐3042.
Gudmunsdottir J, Söderling J, Berggren H, et al. Long‐term clinical effects of early thymectomy: associations with autoimmune diseases, cancer, infections, and atopic diseases. J Allergy Clin Immunol. 2018;141(6):2294‐2297.e8.
Halnon NJ, Cooper P, Chen DY, Boechat MI, Uittenbogaart CH. Immune dysregulation after cardiothoracic surgery and incidental thymectomy: maintenance of regulatory T cells despite impaired thymopoiesis. Clin Dev Immunol. 2011;2011:915864.
Bassett AS, McDonald‐McGinn DM, Devriendt K, et al. Practical guidelines for managing patients with 22q11.2 deletion syndrome. J Pediatr. 2011;159(2):332‐339.e1.
Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483‐491.
Toivonen L, Karppinen S, Schuez‐Havupalo L, et al. Burden of recurrent respiratory tract infections in children: a prospective cohort study. Pediatr Infect Dis J. 2016;35(12):e362‐e369.
Alonso‐Gonzalez R, Borgia F, Diller G‐P, et al. Abnormal lung function in adults with congenital heart disease: prevalence, relation to cardiac anatomy, and association with survival. Circulation. 2013;127(8):882‐890.
StatsDirect Ltd. StatsDirect Statistical Software. http://www.statsdirect.com. StatsDirect Ltd.; 2013.
van Gent R, Schadenberg AWL, Otto SA, et al. Long‐term restoration of the human T‐cell compartment after thymectomy during infancy: a role for thymic regeneration? Blood. 2011;118(3):627‐634.
Cavalcanti NV, Palmeira P, Jatene MB, de Barros DM, Carneiro‐Sampaio M. Early thymectomy is associated with long‐term impairment of the immune system: a systematic review. Front Immunol. 2021;12:774780.
Gudmunsdottir J, Lundqvist C, Ijspeert H, et al. T‐cell receptor sequencing reveals decreased diversity 18 years after early thymectomy. J Allergy Clin Immunol. 2017;140(6):1743‐1746.
Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health consequences of thymus removal in adults. N Engl J Med. 2023;389(5):406‐417.
No Comments.