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Evaluating factors impacting successful immune reconstitution is necessary to improve outcomes. Using data from 10 open-label, single-arm studies, this retrospective cohort study evaluated 76 children with 1-year survival following thymus tissue implantation. Variables included receipt of immune-suppressing agents, human leukocyte antigen (HLA) matching, preimplantation T cell function, and age at implantation. Outcomes include lymphocyte subsets, T cell function, and naive T cell reconstitution, defined as &amp;gt;100 naive T cells\/mm3 at 1-year after implantation. Median total T, B, and NK cell counts at 1 year following implantation were not associated with T cell function at implantation, immune-suppressing therapies, or donor and recipient HLA matching; however, naive T cell counts were higher among those with low T cell function at time of implantation. Younger age at implantation was associated with improved immune reconstitution, supporting the importance of early diagnosis and referral for treatment.<\/jats:p>","DOI":"10.70962\/jhi.20260016","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T06:21:57Z","timestamp":1777098117000},"update-policy":"https:\/\/doi.org\/10.70962\/jhi.crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Rebooting immunity in congenital athymia: Factors impacting reconstitution with thymus implantation"],"prefix":"10.70962","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-0025","authenticated-orcid":true,"given":"Samantha","family":"Cresoe-Ortiz","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University School of Medicine 1 Division of Allergy and Immunology, Department of Pediatrics, , Durham, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9005-3423","authenticated-orcid":true,"given":"Guglielmo","family":"Venturi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University School of Medicine 1 Division of Allergy and Immunology, Department of Pediatrics, , Durham, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0230-9865","authenticated-orcid":true,"given":"Elizabeth A.","family":"McCarthy","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University School of Medicine 1 Division of Allergy and Immunology, Department of Pediatrics, , Durham, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4298-0054","authenticated-orcid":true,"given":"Benjamin","family":"Stewart-Bates","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University School of Medicine 1 Division of Allergy and Immunology, Department of Pediatrics, , Durham, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7939-5102","authenticated-orcid":true,"given":"Jennifer R.","family":"Heimall","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01z7r7q48","id-type":"ROR","asserted-by":"publisher"}],"name":"Children\u2019s Hospital of Philadelphia 2 Division of Allergy and Immunology, , Philadelphia, PA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6394-6843","authenticated-orcid":true,"given":"Eveline Y.","family":"Wu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill 3 Divisions of Pediatric Rheumatology and Pediatric Allergy\/Immunology, Department of Pediatrics, , Chapel Hill, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0078-5867","authenticated-orcid":true,"given":"John W.","family":"Sleasman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University School of Medicine 1 Division of Allergy and Immunology, Department of Pediatrics, , Durham, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1071-4328","authenticated-orcid":true,"given":"Geoffrey","family":"Hall","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University School of Medicine 1 Division of Allergy and Immunology, Department of Pediatrics, , Durham, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"291","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"2026052608594287100_bib1","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.3389\/fimmu.2020.01837","article-title":"T-cell immunodeficiencies with congenital alterations of thymic development: Genes implicated and differential immunological and clinical features","volume":"11","author":"Giardino","year":"2020","journal-title":"Front. 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