Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance

Roosen, Jorg; Oosterlinck, Wouter; Meyns, Bart

doi:10.1093/icvts/ivu343

Cited by 28 publications

(32 citation statements)

References 27 publications

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“…Even though we detected a skewed autoantibody profile after neonatal Tx in early life, in line with previous observations there were no signs of clinical autoimmune disease . Evaluation of specific autoantibodies after Tx was previously assessed, but none of these children had measurable ANA .…”

Section: Discussionsupporting

confidence: 91%

Human neonatal thymectomy induces altered B‐cell responses and autoreactivity

et al. 2017

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An association between T‐cell lymphopenia and autoimmunity has long been proposed, but it remains to be elucidated whether T‐cell lymphopenia affects B‐cell responses to autoantigens. Human neonatal thymectomy (Tx) results in a decrease in T‐cell numbers and we used this model to study the development of autoreactivity. Two cohorts of neonatally thymectomized individuals were examined, a cohort of young (1–5 years post‐Tx, n = 10–27) and older children (>10 years, n = 26), and compared to healthy age‐matched controls. T‐cell and B‐cell subsets were assessed and autoantibody profiling performed. Early post‐Tx, a decrease in T‐cell numbers (2.75 × 109/L vs. 0.71 × 109/L) and an increased proportion of memory T cells (19.72 vs. 57.43%) were observed. The presence of autoantibodies was correlated with an increased proportion of memory T cells in thymectomized children. No differences were seen in percentages of different B‐cell subsets between the groups. The autoantigen microarray showed a skewed autoantibody response after Tx. In the cohort of older individuals, autoantibodies were present in 62% of the thymectomized children, while they were found in only 33% of the healthy controls. Overall, our data suggest that neonatal Tx skews the autoantibody profile. Preferential expansion and preservation of Treg (regulatory T) cell stability and function, may contribute to preventing autoimmune disease development after Tx.

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Section: Discussionsupporting

confidence: 91%

Human neonatal thymectomy induces altered B‐cell responses and autoreactivity

et al. 2017

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“…The minimal residual thymic tissue was sufficient for immune function. In a meta-analysis made by Roosen et al 26 , it was suggested that the thymectomy was responsible for immunological alterations, reduced proportions of RTE and lower numbers of naive T cells. van Gent et al 27 described the impact of thymectomy during early childhood over three decades; so the presence of new TREC-containing naive T cells was suggestive of thymic regeneration.…”

Section: Discussionmentioning

confidence: 99%

Thymic output changes in children with clinical findings signaling a probable primary immunodeficiency

et al. 2019

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output changes in children with clinical findings signaling a probable primary immunodeficiency. Turk J Pediatr 2019; 61: 885-894. Thymic maturation evaluation is inevitable for patients with clinical and laboratory findings for a primary immunodeficiency, as the T cellimmunodeficiencies are the most severe type. In this study, we aimed to show the usage of T cell surface molecule "CD31" for the evaluation of thymic output in patients (n: 66) with a large spectrum of findings signing a probable primary immunodeficiency. Besides the classical clinical and laboratory approach for these patients, T cell subpopulations as naive, memory, recent thymic emigrant cells were also investigated. The humoral immunodeficiency (34.8%), combined immunodeficiency (34.8%) and cardiopathy (7.6%) were the most frequent diagnosis groups. CD4 + CD45RA + naive T-cells percentages (p: 0.011) and absolute counts (p: 0.004) and absolute CD4 + CD45RA + CD31 + RTE (recent thymic emigrant) cell counts (p: 0.007) were significantly lower in combined immunodeficiency group. Naive T-cells (p: 0.037) and RTE cells (p: 0.032) were also lower in patients who had cardiac surgery in the past. In conclusion, flow cytometric CD31 + thymic naive RTE cell evaluation may provide rapid clinical information especially on T-cell immune dysfunction and CD4 + CD45RA + CD31 + RTE cells may be used as an alternative to TRECs in the diagnosis of combined immunodeficiencies.

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“…Total thymectomy in early infancy has effects on circulating T‐cell pools for up to 5 years post‐procedure. However, the functional and clinical significance of this state is unclear, and live vaccination efficacy and safety are unknown . Thymectomy is thought to be rare in kidney and liver transplant recipients.…”

Section: Outcomementioning

confidence: 99%

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Suresh

Upton

Green

et al. 2019

Pediatric Transplantation

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Growing evidence suggests receipt of live‐attenuated viral vaccines after solid organ transplant (SOT) has occurred and is safe and needed due to lapses in herd immunity. A 2‐day consortium of experts in infectious diseases, transplantation, vaccinology, and immunology was held with the objective to review evidence and create expert recommendations for clinicians when considering live viral vaccines post‐SOT. For consideration of VV and MMR post‐transplant, evidence exists only for kidney and liver transplant recipients. For MMR vaccine post‐SOT, consider vaccination during outbreak or travel to endemic risk areas. Patients who have received antiproliferative agents (eg. mycophenolate mofetil), T cell–depleting agents, or rituximab; or have persistently elevated EBV viral loads, or are in a state of functional tolerance, should be vaccinated with caution and have a more in‐depth evaluation to define benefit of vaccination and net state of immune suppression prior to considering vaccination. MMR and/or VV (not combined MMRV) is considered to be safe in patients who are clinically well, are greater than 1 year after liver or kidney transplant and 2 months after acute rejection episode, can be closely monitored, and meet specific criteria of “low‐level” immune suppression as defined in the document.

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Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance

Cited by 28 publications

References 27 publications

Human neonatal thymectomy induces altered B‐cell responses and autoreactivity

Human neonatal thymectomy induces altered B‐cell responses and autoreactivity

Thymic output changes in children with clinical findings signaling a probable primary immunodeficiency

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

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