Long-term immunological changes after corrective cardiac surgery.

IF 4.1 4区 医学 Q2 IMMUNOLOGY
Scandinavian Journal of Immunology Pub Date : 2024-12-01 Epub Date: 2024-10-30 DOI:10.1111/sji.13418
Sevgi Bilgic-Eltan, Razin Amirov, Royale Babayeva, Melek Yorgun Altunbas, Tuba Karakurt, Salim Can, Ezgi Yalcin Gungoren, Selcen Bozkurt, Necmiye Ozturk, Mehmet Cihangir Catak, Alper Bulutoglu, Gizem Onder, Yuk Yin Ng, Ozden Hatırnaz Ng, Elif Karakoc-Aydiner, Ahmet Oguzhan Ozen, Safa Baris
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Abstract

Infants with congenital heart disease (CHD) often undergo thymectomy during corrective cardiac surgery (CCS). The long-term immunological effects remain controversial, with concerns regarding increased susceptibility to infections, allergies, autoimmunity due to compromised immune tolerance mechanisms. This study aims to elucidate the long-term immunological effects of early thymectomy. We enrolled 22 patients who underwent thymectomy in infancy and were followed up in the Pediatric Allergy and Immunology Clinic at Marmara University. We performed demographic characteristics and detailed immunological evaluation, including immunoglobulins, vaccine responses, lymphocyte subset analyses, upregulation, proliferation of T cells and T-cell receptor excision circles (TRECs). Sixteen patients had a history of infection, including six serious infections, all in the first year. Lymphopenia was observed in 27% of patients, with a significant decrease in naive CD4+ and recent thymic emigrant T cells counts and an increase in the proportion of memory T-cells, indicating premature immune senescence. Low levels of IgG, IgA and IgM were found in 36%, 40% and 22% of patients respectively. Vaccine responses were positive in 90% of patients. TREC levels were low in all 10 patients analysed. Seven of nine patients had normal proliferation. Twenty-two percent of patients had allergic disease, and autoimmunity was not observed. Early thymectomy leads to permanent immunological changes that are indicative of early immunosenescence. It is recommended to preserve thymic tissue during surgery and requires long-term follow-up in terms of findings such as allergy and autoimmunity as well as infections due to impaired immune tolerance mechanisms.

心脏矫正手术后的长期免疫学变化。
患有先天性心脏病(CHD)的婴儿在接受心脏矫正手术(CCS)时通常会进行胸腺切除术。其长期免疫学影响仍存在争议,人们担心免疫耐受机制受损会增加感染、过敏和自身免疫的易感性。本研究旨在阐明早期胸腺切除术的长期免疫学影响。我们招募了 22 名在婴儿期接受胸腺切除术的患者,并在马尔马拉大学儿科过敏与免疫学诊所进行了随访。我们对这些患者进行了人口统计学特征和详细的免疫学评估,包括免疫球蛋白、疫苗反应、淋巴细胞亚群分析、T细胞上调、增殖和T细胞受体切割圈(TRECs)。16 名患者有感染史,其中包括 6 次严重感染,均发生在第一年。27%的患者出现淋巴细胞减少症,幼稚CD4+和近期胸腺移出T细胞数量显著减少,记忆T细胞比例增加,表明免疫过早衰老。分别有 36%、40% 和 22% 的患者 IgG、IgA 和 IgM 水平较低。90%的患者对疫苗反应呈阳性。所分析的 10 名患者的 TREC 水平都很低。九名患者中有七名增殖正常。22%的患者患有过敏性疾病,未观察到自身免疫。早期胸腺切除会导致永久性的免疫学变化,表明早期免疫衰老。建议在手术中保留胸腺组织,并需要长期随访,以发现过敏、自身免疫以及因免疫耐受机制受损而导致的感染等情况。
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来源期刊
CiteScore
7.70
自引率
5.40%
发文量
109
审稿时长
1 months
期刊介绍: This peer-reviewed international journal publishes original articles and reviews on all aspects of basic, translational and clinical immunology. The journal aims to provide high quality service to authors, and high quality articles for readers. The journal accepts for publication material from investigators all over the world, which makes a significant contribution to basic, translational and clinical immunology.
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