Impact of thymectomy on immune function: Long-term risks and clinical management_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Xiaoting ^1,2,3 , PAN Zulin ^1,2,3 , LIU Peng ^1,2,3 ,  QI Guoyan ^1,2,3

1. Myasthenia Gravis Diagnosis and Treatment Center of Hebei Province, Shijiazhuang People's Hospital, Shijiazhuang, 050000, P. R. China;
2. Hebei Province Key Laboratory of Myasthenia Gravis, Shijiazhuang, 050000, P. R. China;
3. Hebei Province Clinical Medical Research Center for Myasthenia Gravis, Shijiazhuang, 050000, P. R. China;

Corresponding?author：

QI Guoyan, Email: zzjwlsys@163.com

Keywords：

Thymectomy; myasthenia gravis; thymoma; immune function; long-term risk; risk-compensation balance model

DOI：

10.7507/1007-4848.202511040

Video：

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Abstract Full text Figures/Tables Video References Cited by

The thymus is a key organ for T-cell development and the establishment of central immune tolerance. Research on immune function changes and long-term health risks following thymectomy is characterized by significant population heterogeneity and controversial conclusions. This article systematically reviews the key immunological alterations after thymectomy - including reduced T-cell receptor (TCR) repertoire diversity, regulatory T cell (Treg) dysfunction, accelerated immune aging, and compensatory immune responses, and clarifies population differences in postoperative risks of infection, autoimmune diseases, and tumors, as well as the impact of surgical approaches. The clinical outcome after thymectomy is not solely determined by thymus loss, but rather depends on a dynamic balance between "immune deficiency risk" and "host compensatory capacity," which is modulated by multiple factors such as age at surgery, extent of resection, and individual immune status. This review proposes a "risk-compensation balance model" framework, providing an integrated theoretical basis for explaining the heterogeneity in outcomes across different populations and surgical methods. It also holds significant implications for future efforts in individualized surgical decision-making, establishment of stratified immune monitoring systems, and exploration of targeted immune intervention strategies.

Citation： LIN Xiaoting, PAN Zulin, LIU Peng, QI Guoyan. Impact of thymectomy on immune function: Long-term risks and clinical management. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(2): 211-217. doi: 10.7507/1007-4848.202511040 Copy

1.	Stosio M, Ruszkowski J, Mikosik-Roczyńska A, et al. The significance of neonatal thymectomy for shaping the immune system in children with congenital heart defects. Kardiochir Torakochirurgia Pol, 2017, 14(4): 258-262.
2.	Steinmann GG, Klaus B, Müller-Hermelink HK. The involution of the ageing human thymic epithelium is independent of puberty. a morphometric study. Scand J Immunol, 1985, 22(5): 563-575.
3.	Jamieson BD, Douek DC, Killian S, et al. Generation of functional thymocytes in the human adult. Immunity, 1999, 10(5): 569-575.
4.	Naylor K, Li G, Vallejo AN, et al. The influence of age on T cell generation and TCR diversity. J Immunol, 2005, 174(11): 7446-7452.
5.	Douek DC, McFarland RD, Keiser PH, et al. Changes in thymic function with age and during the treatment of HIV infection. Nature, 1998, 396(6712): 690-695.
6.	Kooshesh KA, Foy BH, Sykes DB, et al. Health consequences of thymus removal in adults. N Engl J Med, 2023, 389(5): 406-417.
7.	Morganroth J, Zuroff L, Guidon AC, et al. Trends and disparities in the utilization of thymectomy for myasthenia gravis in the United States. Neurol Clin Pract, 2024, 14(5): e200335.
8.	Asnaghi MA, Barthlott T, Gullotta F, et al. Thymus extracellular matrix-derived scaffolds support graft-resident thymopoiesis and long-term in vitro culture of adult thymic epithelial cells. Adv Funct Mater, 2021, 31(20): 2010747.
9.	Kondo K, Ohigashi I, Takahama Y. Thymus machinery for T-cell selection. Int Immunol, 2019, 31(3): 119-125.
10.	Wang H, Zú?iga-Pflücker JC. Thymic microenvironment: interactions between innate immune cells and developing thymocytes. Front Immunol, 2022, 13: 885280.
11.	Ferreirinha P, Pinheiro RGR, Landry JJM, et al. Identification of fibroblast progenitors in the developing mouse thymus. Development, 2022, 149(10): dev200513.
12.	Muro R, Nitta T. It's time to unite: diversity and coordination of thymic stromal cells for T cell selection and organ integrity. Immunol Rev, 2025, 332(1): e70040.
13.	Cavalcanti NV, Palmeira P, Jatene MB, et al. Early thymectomy is associated with long-term impairment of the immune system: a systematic review. Front Immunol, 2021, 12: 774780.
14.	Popperud TH, Gul KA, Brunborg C, et al. Thymectomy in juvenile myasthenia gravis is safe regarding long term immunological effects. Front Neurol, 2021, 12: 596859.
15.	Bains I, Thiébaut R, Yates AJ, et al. Quantifying thymic export: combining models of naive T cell proliferation and TCR excision circle dynamics gives an explicit measure of thymic output. J Immunol, 2009, 183(7): 4329-4336.
16.	Zhang B, Jia Q, Bock C, et al. Glimpse of natural selection of long-lived T-cell clones in healthy life. Proc Natl Acad Sci U S A, 2016, 113(35): 9858-9863.
17.	Bernaldo-de-Quirós E, López-Abente J, Camino M, et al. The presence of a marked imbalance between regulatory T cells and effector T cells reveals that tolerance mechanisms could be compromised in heart transplant children. Transplant Direct, 2021, 7(5): e693.
18.	Herbin O, Bonito AJ, Jeong S, et al. Medullary thymic epithelial cells and CD8α+ dendritic cells coordinately regulate central tolerance but CD8α+ cells are dispensable for thymic regulatory T cell production. J Autoimmun, 2016, 75: 141-149.
19.	Almeida-Santos J, Bergman ML, Cabral IA, et al. Interruption of thymic activity in adult mice improves responses to tumor immunotherapy. J Immunol, 2021, 206(5): 978-986.
20.	Severin ME, Lee PW, Liu Y, et al. MicroRNAs targeting TGFβ signalling underlie the regulatory T cell defect in multiple sclerosis. Brain, 2016, 139(Pt 6): 1747-1761.
21.	Lee V, Rodriguez DM, Ganci NK, et al. The endogenous repertoire harbors self-reactive CD4+ T cell clones that adopt a follicular helper T cell-like phenotype at steady state. Nat Immunol, 2023, 24(3): 487-500.
22.	Silva SL, Albuquerque A, Amaral AJ, et al. Autoimmunity and allergy control in adults submitted to complete thymectomy early in infancy. PLoS One, 2017, 12(7): e0180385.
23.	Merz M, Hu Q, Merz AMA, et al. Spatiotemporal assessment of immunogenomic heterogeneity in multiple myeloma. Blood Adv, 2023, 7(5): 718-733.
24.	Goggins JA, Kurtz JR, McLachlan JB. Control of persistent Salmonella infection relies on constant thymic output despite increased peripheral antigen-specific T cell immunity. Pathogens, 2020, 9(8): 605.
25.	Deng Y, Peng Z, Ming K, et al. Single-cell analysis of human thymus and peripheral blood unveils the dynamics of T cell development and aging. Nat Aging, 2025, 5(12): 2494-2513.
26.	Rantanen R, Honkila M, K?m? HR, et al. Pneumonia, wheezing and asthma were more common in children after thymectomy due to open-heart surgery. Acta Paediatr, 2024, 113(7): 1685-1693.
27.	Gudmundsdottir J, S?derling 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.
28.	Roosen J, Oosterlinck W, Meyns B. Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance. Interact Cardiovasc Thorac Surg, 2015, 20(1): 101-106.
29.	Halnon NJ, Jamieson B, Plunkett M, et al. Thymic function and impaired maintenance of peripheral T cell populations in children with congenital heart disease and surgical thymectomy. Pediatr Res, 2005, 57(1): 42-48.
30.	Schadenberg AW, van den Broek T, Siemelink MA, et al. Differential homeostatic dynamics of human regulatory T-cell subsets following neonatal thymectomy. J Allergy Clin Immunol, 2014, 133(1): 277-280. e6.
31.	Detterbeck FC, Kaminski HJ, Blasberg JD, et al. Does thymectomy in adults have long-term health consequences? J Thorac Cardiovasc Surg, 2025, 169(3): 787-795. e2.
32.	Bilgic-Eltan S, Amirov R, Babayeva R, et al. Long-term immunological changes after corrective cardiac surgery. Scand J Immunol, 2024, 100(6): e13418.
33.	Kes?l?inen A, Rantanen R, Honkila M, et al. Effects of antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability following paediatric open-heart surgery and thymectomy: a single-centre retrospective cohort study. BMJ Paediatr Open, 2024, 8(1): e002651.
34.	Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
35.	Chang CC, Lin TM, Chang YS, et al. Thymectomy in patients with myasthenia gravis increases the risk of autoimmune rheumatic diseases: a nationwide cohort study. Rheumatology (Oxford), 2019, 58(1): 135-143.
36.	Filosso PL, Galassi C, Ruffini E, et al. Thymoma and the increased risk of developing extrathymic malignancies: a multicentre study. Eur J Cardiothorac Surg, 2013, 44(2): 219-224.
37.	Haque W, Pietroluongo E, Fatima J, et al. Management of autoimmune conditions associated with thymic epithelial tumors. J Thorac Oncol, 2025: S1556-0864(25)01063-9.
38.	Masaoka A, Yamakawa Y, Niwa H, et al. Thymectomy and malignancy. Eur J Cardiothorac Surg, 1994, 8(5): 251-253.
39.	Resio BJ, Canavan M, Caturegli G, et al. Mortality risk and cause of death associated with removal of the adult thymus: analysis of the U. S. thymoma population. J Thorac Oncol, 2025, 20(8): 1345-1548.
40.	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.
41.	Afifi A, Raja SG, Pennington DJ, et al. For neonates undergoing cardiac surgery does thymectomy as opposed to thymic preservation have any adverse immunological consequences? Interact Cardiovasc Thorac Surg, 2010, 11(3): 287-291.
42.	Riely GJ, Wood DE, Loo BW, et al. Thymomas and thymic carcinomas, version 2. 2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2025, 23(6): 255-269.
43.	Hayashi T, Okazaki M, Mitsuhashi T, et al. Total thymectomy is oncologically superior to partial thymectomy in patients with thymic carcinoma: insights from a multicenter real-world data analysis. Int J Surg, 2025, 111(10): 6894-6904.
44.	Dion ML, Sékaly RP, Cheynier R. Estimating thymic function through quantification of T-cell receptor excision circles. Methods Mol Biol, 2007, 380: 197-213.
45.	Middelkamp V, Kek?l?inen E. Measuring thymic output across the human lifespan: a critical challenge in laboratory medicine. Geroscience, 2025, 47(6): 6797-6806.
46.	Wysoczańska B. T-cell receptor rearrangement excision circles (TRECs) as a marker of thymic function. Postepy Hig Med Dosw (Online), 2008, 62: 708-724.
47.	Sandhar B, Vyas V, Harding D, et al. Heterogeneity of thymic output in the elderly and its association with sex and smoking. JCI Insight, 2025, 10(15): e189008.
48.	Kim AG, Upah SA, Brandsema JF, et al. Thoracoscopic thymectomy for juvenile myasthenia gravis. Pediatr Surg Int, 2019, 35(5): 603-610.
49.	May I, Akunuri S. COVID-19 and Good's syndrome after thymectomy. Cureus, 2024, 16(9): e70274.
50.	Harji DP, Jaunoo SS, Mistry P, et al. Immunoprophylaxis in asplenic patients. Int J Surg, 2009, 7(5): 421-423.
51.	Farmakis D, Porter J, Taher A, et al. 2021 Thalassaemia International Federation guidelines for the management of transfusion-dependent thalassemia. Hemasphere, 2022, 6(8): e732.
52.	Granadier D, Acenas D 2nd, Dudakov JA. Endogenous thymic regeneration: restoring T cell production following injury. Nat Rev Immunol, 2025, 25(6): 407-424.
53.	See KC. Vaccination for the prevention of infection among immunocompromised patients: a concise review of recent systematic reviews. Vaccines (Basel), 2022, 10(5): 800.
54.	Pala F, Notarangelo LD, Lionakis MS. Thymic inborn errors of immunity. J Allergy Clin Immunol, 2025, 155(2): 368-376.
55.	Dong JP, Gao W, Teng GG, et al. Characteristics of Good's syndrome in China: a systematic review. Chin Med J (Engl), 2017, 130(13): 1604-1609.
56.	Chaudhry MS, Velardi E, Dudakov JA, et al. Thymus: the next (re)generation. Immunol Rev, 2016, 271(1): 56-71.
57.	Duah M, Li L, Shen J, et al. Thymus degeneration and regeneration. Front Immunol, 2021, 12: 706244.
58.	Kinsella S, Dudakov JA. When the damage is done: injury and repair in thymus function. Front Immunol, 2020, 11: 1745.
59.	Moore EM, Maestas DR Jr, Comeau HY, et al. The immune system and its contribution to variability in regenerative medicine. Tissue Eng Part B Rev, 2021, 27(1): 39-47.
60.	Okuda K, Hattori H, Yokota K, et al. Examination on the necessity of pericardial fat tissue resection in extended thymectomy for myasthenia gravis. Gland Surg, 2021, 10(8): 2438-2444.
61.	Li F, Tao Y, Bauer G, et al. Unraveling the role of ectopic thymic tissue in patients undergoing thymectomy for myasthenia gravis. J Thorac Dis, 2019, 11(9): 4039-4048.
62.	Moore C, Karamlou T, Morales DLS. Collateral damage from congenital heart surgery: can thymic reimplantation restore immune competence? Circulation, 2025, 152(17): 1191-1193.

1. Stosio M, Ruszkowski J, Mikosik-Roczyńska A, et al. The significance of neonatal thymectomy for shaping the immune system in children with congenital heart defects. Kardiochir Torakochirurgia Pol, 2017, 14(4): 258-262.
2. Steinmann GG, Klaus B, Müller-Hermelink HK. The involution of the ageing human thymic epithelium is independent of puberty. a morphometric study. Scand J Immunol, 1985, 22(5): 563-575.
3. Jamieson BD, Douek DC, Killian S, et al. Generation of functional thymocytes in the human adult. Immunity, 1999, 10(5): 569-575.
4. Naylor K, Li G, Vallejo AN, et al. The influence of age on T cell generation and TCR diversity. J Immunol, 2005, 174(11): 7446-7452.
5. Douek DC, McFarland RD, Keiser PH, et al. Changes in thymic function with age and during the treatment of HIV infection. Nature, 1998, 396(6712): 690-695.
6. Kooshesh KA, Foy BH, Sykes DB, et al. Health consequences of thymus removal in adults. N Engl J Med, 2023, 389(5): 406-417.
7. Morganroth J, Zuroff L, Guidon AC, et al. Trends and disparities in the utilization of thymectomy for myasthenia gravis in the United States. Neurol Clin Pract, 2024, 14(5): e200335.
8. Asnaghi MA, Barthlott T, Gullotta F, et al. Thymus extracellular matrix-derived scaffolds support graft-resident thymopoiesis and long-term in vitro culture of adult thymic epithelial cells. Adv Funct Mater, 2021, 31(20): 2010747.
9. Kondo K, Ohigashi I, Takahama Y. Thymus machinery for T-cell selection. Int Immunol, 2019, 31(3): 119-125.
10. Wang H, Zú?iga-Pflücker JC. Thymic microenvironment: interactions between innate immune cells and developing thymocytes. Front Immunol, 2022, 13: 885280.
11. Ferreirinha P, Pinheiro RGR, Landry JJM, et al. Identification of fibroblast progenitors in the developing mouse thymus. Development, 2022, 149(10): dev200513.
12. Muro R, Nitta T. It's time to unite: diversity and coordination of thymic stromal cells for T cell selection and organ integrity. Immunol Rev, 2025, 332(1): e70040.
13. Cavalcanti NV, Palmeira P, Jatene MB, et al. Early thymectomy is associated with long-term impairment of the immune system: a systematic review. Front Immunol, 2021, 12: 774780.
14. Popperud TH, Gul KA, Brunborg C, et al. Thymectomy in juvenile myasthenia gravis is safe regarding long term immunological effects. Front Neurol, 2021, 12: 596859.
15. Bains I, Thiébaut R, Yates AJ, et al. Quantifying thymic export: combining models of naive T cell proliferation and TCR excision circle dynamics gives an explicit measure of thymic output. J Immunol, 2009, 183(7): 4329-4336.
16. Zhang B, Jia Q, Bock C, et al. Glimpse of natural selection of long-lived T-cell clones in healthy life. Proc Natl Acad Sci U S A, 2016, 113(35): 9858-9863.
17. Bernaldo-de-Quirós E, López-Abente J, Camino M, et al. The presence of a marked imbalance between regulatory T cells and effector T cells reveals that tolerance mechanisms could be compromised in heart transplant children. Transplant Direct, 2021, 7(5): e693.
18. Herbin O, Bonito AJ, Jeong S, et al. Medullary thymic epithelial cells and CD8α+ dendritic cells coordinately regulate central tolerance but CD8α+ cells are dispensable for thymic regulatory T cell production. J Autoimmun, 2016, 75: 141-149.
19. Almeida-Santos J, Bergman ML, Cabral IA, et al. Interruption of thymic activity in adult mice improves responses to tumor immunotherapy. J Immunol, 2021, 206(5): 978-986.
20. Severin ME, Lee PW, Liu Y, et al. MicroRNAs targeting TGFβ signalling underlie the regulatory T cell defect in multiple sclerosis. Brain, 2016, 139(Pt 6): 1747-1761.
21. Lee V, Rodriguez DM, Ganci NK, et al. The endogenous repertoire harbors self-reactive CD4+ T cell clones that adopt a follicular helper T cell-like phenotype at steady state. Nat Immunol, 2023, 24(3): 487-500.
22. Silva SL, Albuquerque A, Amaral AJ, et al. Autoimmunity and allergy control in adults submitted to complete thymectomy early in infancy. PLoS One, 2017, 12(7): e0180385.
23. Merz M, Hu Q, Merz AMA, et al. Spatiotemporal assessment of immunogenomic heterogeneity in multiple myeloma. Blood Adv, 2023, 7(5): 718-733.
24. Goggins JA, Kurtz JR, McLachlan JB. Control of persistent Salmonella infection relies on constant thymic output despite increased peripheral antigen-specific T cell immunity. Pathogens, 2020, 9(8): 605.
25. Deng Y, Peng Z, Ming K, et al. Single-cell analysis of human thymus and peripheral blood unveils the dynamics of T cell development and aging. Nat Aging, 2025, 5(12): 2494-2513.
26. Rantanen R, Honkila M, K?m? HR, et al. Pneumonia, wheezing and asthma were more common in children after thymectomy due to open-heart surgery. Acta Paediatr, 2024, 113(7): 1685-1693.
27. Gudmundsdottir J, S?derling 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.
28. Roosen J, Oosterlinck W, Meyns B. Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance. Interact Cardiovasc Thorac Surg, 2015, 20(1): 101-106.
29. Halnon NJ, Jamieson B, Plunkett M, et al. Thymic function and impaired maintenance of peripheral T cell populations in children with congenital heart disease and surgical thymectomy. Pediatr Res, 2005, 57(1): 42-48.
30. Schadenberg AW, van den Broek T, Siemelink MA, et al. Differential homeostatic dynamics of human regulatory T-cell subsets following neonatal thymectomy. J Allergy Clin Immunol, 2014, 133(1): 277-280. e6.
31. Detterbeck FC, Kaminski HJ, Blasberg JD, et al. Does thymectomy in adults have long-term health consequences? J Thorac Cardiovasc Surg, 2025, 169(3): 787-795. e2.
32. Bilgic-Eltan S, Amirov R, Babayeva R, et al. Long-term immunological changes after corrective cardiac surgery. Scand J Immunol, 2024, 100(6): e13418.
33. Kes?l?inen A, Rantanen R, Honkila M, et al. Effects of antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability following paediatric open-heart surgery and thymectomy: a single-centre retrospective cohort study. BMJ Paediatr Open, 2024, 8(1): e002651.
34. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
35. Chang CC, Lin TM, Chang YS, et al. Thymectomy in patients with myasthenia gravis increases the risk of autoimmune rheumatic diseases: a nationwide cohort study. Rheumatology (Oxford), 2019, 58(1): 135-143.
36. Filosso PL, Galassi C, Ruffini E, et al. Thymoma and the increased risk of developing extrathymic malignancies: a multicentre study. Eur J Cardiothorac Surg, 2013, 44(2): 219-224.
37. Haque W, Pietroluongo E, Fatima J, et al. Management of autoimmune conditions associated with thymic epithelial tumors. J Thorac Oncol, 2025: S1556-0864(25)01063-9.
38. Masaoka A, Yamakawa Y, Niwa H, et al. Thymectomy and malignancy. Eur J Cardiothorac Surg, 1994, 8(5): 251-253.
39. Resio BJ, Canavan M, Caturegli G, et al. Mortality risk and cause of death associated with removal of the adult thymus: analysis of the U. S. thymoma population. J Thorac Oncol, 2025, 20(8): 1345-1548.
40. 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.
41. Afifi A, Raja SG, Pennington DJ, et al. For neonates undergoing cardiac surgery does thymectomy as opposed to thymic preservation have any adverse immunological consequences? Interact Cardiovasc Thorac Surg, 2010, 11(3): 287-291.
42. Riely GJ, Wood DE, Loo BW, et al. Thymomas and thymic carcinomas, version 2. 2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2025, 23(6): 255-269.
43. Hayashi T, Okazaki M, Mitsuhashi T, et al. Total thymectomy is oncologically superior to partial thymectomy in patients with thymic carcinoma: insights from a multicenter real-world data analysis. Int J Surg, 2025, 111(10): 6894-6904.
44. Dion ML, Sékaly RP, Cheynier R. Estimating thymic function through quantification of T-cell receptor excision circles. Methods Mol Biol, 2007, 380: 197-213.
45. Middelkamp V, Kek?l?inen E. Measuring thymic output across the human lifespan: a critical challenge in laboratory medicine. Geroscience, 2025, 47(6): 6797-6806.
46. Wysoczańska B. T-cell receptor rearrangement excision circles (TRECs) as a marker of thymic function. Postepy Hig Med Dosw (Online), 2008, 62: 708-724.
47. Sandhar B, Vyas V, Harding D, et al. Heterogeneity of thymic output in the elderly and its association with sex and smoking. JCI Insight, 2025, 10(15): e189008.
48. Kim AG, Upah SA, Brandsema JF, et al. Thoracoscopic thymectomy for juvenile myasthenia gravis. Pediatr Surg Int, 2019, 35(5): 603-610.
49. May I, Akunuri S. COVID-19 and Good's syndrome after thymectomy. Cureus, 2024, 16(9): e70274.
50. Harji DP, Jaunoo SS, Mistry P, et al. Immunoprophylaxis in asplenic patients. Int J Surg, 2009, 7(5): 421-423.
51. Farmakis D, Porter J, Taher A, et al. 2021 Thalassaemia International Federation guidelines for the management of transfusion-dependent thalassemia. Hemasphere, 2022, 6(8): e732.
52. Granadier D, Acenas D 2nd, Dudakov JA. Endogenous thymic regeneration: restoring T cell production following injury. Nat Rev Immunol, 2025, 25(6): 407-424.
53. See KC. Vaccination for the prevention of infection among immunocompromised patients: a concise review of recent systematic reviews. Vaccines (Basel), 2022, 10(5): 800.
54. Pala F, Notarangelo LD, Lionakis MS. Thymic inborn errors of immunity. J Allergy Clin Immunol, 2025, 155(2): 368-376.
55. Dong JP, Gao W, Teng GG, et al. Characteristics of Good's syndrome in China: a systematic review. Chin Med J (Engl), 2017, 130(13): 1604-1609.
56. Chaudhry MS, Velardi E, Dudakov JA, et al. Thymus: the next (re)generation. Immunol Rev, 2016, 271(1): 56-71.
57. Duah M, Li L, Shen J, et al. Thymus degeneration and regeneration. Front Immunol, 2021, 12: 706244.
58. Kinsella S, Dudakov JA. When the damage is done: injury and repair in thymus function. Front Immunol, 2020, 11: 1745.
59. Moore EM, Maestas DR Jr, Comeau HY, et al. The immune system and its contribution to variability in regenerative medicine. Tissue Eng Part B Rev, 2021, 27(1): 39-47.
60. Okuda K, Hattori H, Yokota K, et al. Examination on the necessity of pericardial fat tissue resection in extended thymectomy for myasthenia gravis. Gland Surg, 2021, 10(8): 2438-2444.
61. Li F, Tao Y, Bauer G, et al. Unraveling the role of ectopic thymic tissue in patients undergoing thymectomy for myasthenia gravis. J Thorac Dis, 2019, 11(9): 4039-4048.
62. Moore C, Karamlou T, Morales DLS. Collateral damage from congenital heart surgery: can thymic reimplantation restore immune competence? Circulation, 2025, 152(17): 1191-1193.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of thymectomy on immune function: Long-term risks and clinical management

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