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J Thorac Cardiovasc Surg 1998;115:1041-1045
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Neonatal thymectomy: Does it affect immune function?

Read at the Seventy-seventh Annual Meeting of The American Associationfor Thoracic Surgery, Washington, D.C., May 4-7, 1997.

Received for publication May 6, 1997. Revisions requested June 30, 1997. Revisions received Dec. 29, 1997. Accepted for publication Dec. 29, 1997. Address for reprints: Winfield J. Wells, MD, Associate Professor ofSurgery, Division of Cardiothoracic Surgery, Childrens Hospital Los Angeles,4650 Sunset Blvd., MS 66, Los Angeles, CA 90027.

Objective: The purpose of this study wasto determine whether thymectomy in the newborn has a negative effect on immunefunction.
Methods: Twenty-five neonates (<30days) who had thymectomy at congenital heart repair were prospectively studiedto determine immune function. The percentage of T-cell subtypes including CD3(all T cells), CD4 (helper T cells), and CD8 (suppressor T cells) wasdetermined. In six patients, further testing of CD4 cells was done to determinewhether they were newly formed, recent thymic emigrants (CD4, CD45, and RA), orolder educated lymphocytes (CD4, CD45, and RO). Response to the mitogenphytohemagglutinin and to tetanus toxoid were determined, as were antibodytiters to tetanus. Samples were drawn before the thymectomy, at approximately 3months after immunization and at 1 year. Ten age-matched control patients weretested. At follow-up, parents were asked about infections.
Results: Prethymectomy T-cell subsets were all normal andcomparable to controls. At 12 months, the percent of CD3 was significantly lessthan in the control group (48% ± 3% versus 64%± 2% [mean ± standard error of the mean];p  < 0.01) as was CD4 (31%± 2% versus 46% + 2% [mean ± standarderror of the mean]; p = < 0.01). CD8 didnot drop. Surprisingly, the percent of CD4 that were recent thymic emigrants didnot decrease significantly (50% ± 8% versus 60%± 6% [mean ± standard error of the mean];p = not significant). Lymphocyteblastogenesis to phytohemagglutinin and tetanus toxoid and antibody to tetanuswere all normal at 12 months. No patient required readmission for infection, andthere were the expected number of minor infectious events (median 3; 95%confidence interval 1,4).
Conclusion:Thymectomy in neonates results in a modest but significant decrease inT-lymphocyte levels, but there is no compromise in immune function. (J Thorac Cardiavasc Surg 1998;115:1041-6)

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