Improvement of graft prognosis in penetrating normal-risk keratoplasty by HLA class I and II matching

Abstract

Background Owing to contradictory results, HLA matching in penetrating keratoplasty still is equivocal. Different surgical techniques in multicentre studies, missing risk differentiation in high-risk situations, and faulty HLA typing can be identified as main reasons for these contradictory results. In this monocentre study, the value of HLA class I and II matching (A, B, DR loci) was examined in a homogeneous group of 418 normal-risk keratoplasty patients using serological typing techniques for HLA class I and immunogenetic typing techniques for class II. Methods Penetrating normal-risk keratoplasty was performed in two groups of patients (group I with 0-2, group II with 3-6 mismatches in the A/B/DR loci). All surgery was carried out by three experienced surgeons according to a standardized scheme. Furthermore, postoperative therapy and controls were standardized. There were no statistically significant differences between the two study groups with regard to the number of ABO or H-Y compatibilities, patient age, patient gender, ratio of previous intraocular surgery, ratio of triple procedures, indication for surgery, follow-up period, donor age, donor gender, post-mortem time of the graft, and endothelial cell density of the graft at the end of organ culture. All HLA typing was performed in a quality-controlled laboratory, serologically for HLA class I (A and B loci) and immunogenetically for HLA class II (DR locus). Results At 4 years postoperatively, the ratio of clear and rejection-free graft survival was 92% in group I and 66% in group II (KaplanMeier estimation, log rank test, P ¼ 0.03). Monovariate analysis in the Cox model gave no influence of solitary HLA class I or II

Bevacizumab (Avastin) and Argon Laser to Treat Neovascularization in Corneal Transplant Surgery

“…In both of our patients' cases, the waiting period for an HLA-matched transplant was considered to be too long. 14 Obviously, we cannot distinguish the impact of the additional medication from the bevacizumab-argon laser treatment effect on transplant survival in these 2 cases. Maybe these transplants would have done well without bevacizumab and/or argon coagulation as well.…”

“…10,11 In recent years, numerous efforts have been made to reduce or eliminate risk factors that can lead to corneal graft rejections. These have included improvements in surgical methods, including new transplantation techniques, better transplant-recipient interfaces, and optimized secondary intraocular lens implants 12,13 ; immunological approaches, such as HLA matching 9,14 ; and immune response-modulating drugs. 11,[15][16][17] Argon laser-induced coagulation provides a potential treatment in closing pathologic blood vessels in the cornea.…”

Risk factors, clinical presentations, prevention, and treatment of corneal graft rejection

“…Существует ряд исследо-ваний, доказывающих преимущества типирования на HLA типа I (HLA -human leukocyte antigen), осо-бенно у пациентов с «высоким риском» отторжения роговичного трансплантата [2,8,9]. Данные по це-лесообразности типирования HLA типа II неодно-родны и противоречивы.…”

Basiliximab als Monotherapie nach perforierender Risikokeratoplastik - eine prospektive randomisierte Pilotstudie

“…B. Rekeratoplastik, limbusnahe Transplantatposition, Vaskularisationen der Wirtshornhaut, etc.). So beträgt das immunreaktionsfreie Transplantatüberleben in manchen Hochrisikogruppen teilweise nur 15% nach 5 Jahren [18] verglichen mit 80 % bei Normalrisikokeratoplastiken [14]. Die Prognose der Hornhauttransplantationen mit erhçhtem Abstoßungsrisiko hat sich erheblich verbessert durch die Einführung der systemischen Immunsuppression [3,5,6,8,14,16,21].…”

“…So beträgt das immunreaktionsfreie Transplantatüberleben in manchen Hochrisikogruppen teilweise nur 15% nach 5 Jahren [18] verglichen mit 80 % bei Normalrisikokeratoplastiken [14]. Die Prognose der Hornhauttransplantationen mit erhçhtem Abstoßungsrisiko hat sich erheblich verbessert durch die Einführung der systemischen Immunsuppression [3,5,6,8,14,16,21]. Derzeit wird an den meisten Zentren in Deutschland bei Risikokeratoplastiken zusätzlich zur lokalen Immunsuppression eine mittelfristige systemische Immunsuppression mit Ciclosporin A (CSA) oder Mycophenolatmofetil (MMF) durchgeführt [2,6,21].…”