Adequate HLA Matching in Keratoplasty (Developments in by R. Sundmacher, F. Bandello

By R. Sundmacher, F. Bandello

‘Immunologic privilege’ of the cornea and anterior chamber has, typically, been believed to be a adequate warrantly for survival of the donor cornea. If this failed, it was once suggestion that adjunctive immunomodulating brokers may compensate. however the query of the way to deal with higher tolerance and more secure long term survival of corneal grafts after withdrawal of a powerful immunomodulating protect nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and scientific features are mentioned by means of popular scientific and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, in reality, a necessary adjunct for long term survival of corneal grafts not just in these at excessive hazard yet significantly additionally in sufferers at common hazard. This quantity opens new pathways in the direction of the winning program of HLA matching to keratoplasty surgeons, experimental and medical immunologists and cornea financial institution officials, whilst appearing as an relief to ophthalmologists whilst discovering the foundation to thoroughly propose their keratoplasty sufferers.

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Example text

The significance of differences between classes was assessed with a ␹2 statistic derived from a log-rank test [35]. Relative risk (RR) estimates were derived from the values in the logrank tables. The absence of any rejection episode, reversible or irreversible, is a more sensitive and appropriate indicator of the immune competence of corneal transplant recipients than the time to irreversible immunological rejection that is really an indication of the efficacy of follow-up procedures, especially the immunosuppressive therapy protocols, of transplantation centers.

30] cited four possible reasons for disparate results in kidney transplantation follow-up studies: (1) poor quality HLA typing negates the effect of matching; (2) when the number of good (or poor) matches is low, a matching effect is not demonstrable; (3) aggressive immunotherapy might diminish the influence of HLA matching on graft survival (however, at the cost of other complications such as malignancies [31, 32]), and (4) racial heterogeneity can make it impossible to obtain good matches. We avoided the adverse effects of those factors by performing a comprehensive study of the immune response to HLA-A, -B and -DR histoincompatibilities in 1,681 consecutive recipients of penetrating keratoplasties which were Histocompatibility and Corneal Transplantation 23 performed by a single surgeon, in a single center, over a 20-year period, 1976–1996 [33].

Compared to other studies, this study offers five advantages: (1) In a monocenter design only 3 experienced surgeons performed all transplantations according to a standardized scheme. Also, all postoperative therapy and all postoperative examinations were performed in a standardized manner. (2) Only normal-risk keratoplasty patients were considered for the study in order to minimize the influence of non-immunological risk factors. (3) Various patient, donor and graft parameters may influence clear and rejection-free graft survival.

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