By R. Sundmacher, F. Bandello
‘Immunologic privilege’ of the cornea and anterior chamber has, commonly, been believed to be a enough warrantly for survival of the donor cornea. If this failed, it was once idea that adjunctive immunomodulating brokers might 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 safeguard nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and scientific facets 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 beneficial adjunct for long term survival of corneal grafts not just in these at excessive hazard yet particularly additionally in sufferers at general possibility. This quantity opens new pathways in the direction of the profitable program of HLA matching to keratoplasty surgeons, experimental and scientific immunologists and cornea financial institution officials, even as appearing as an relief to ophthalmologists while discovering the foundation to accurately suggest their keratoplasty sufferers.
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Extra resources for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)
S. s. s. s. s. s. s. s. 1 ANOVA, 2 test. s. ϭ not significant; kk ϭ keratoconus; Fed ϭ Fuchs endothelial dystrophy; other ϭ bullous keratopathy or non-herpetic avascular scars; Ecd ϭ endothelial cell density. 4). Grafts All grafts were preserved in organ culture according to the guidelines of the European Eye Bank Association . Preoperative evaluation of the graft endothelium was performed in hypotonic solution under the phase-contrast microscope the day before penetrating keratoplasty .
Results of monovariate analyses; failure is irreversible immunological rejection only Factor log-rank p value % clear grafts at 5 years Casesa Retransplantation: yes/no Vascularization: high/low riskb HLA-A, -B mism: 3–4/0–2 (see fig. 1) HLA-DR mism: 1–2/0 (see fig. 003 77/85 81/94 67/85 83/97 75/85 68/84 77/85 74/84 388/463 851/530 207/642 214/066 298/553 144/707 436/415 267/584 mism ϭ Mismatches; p value ϭ significance of the difference between the 2 survival curves. a Cases: For transplant number, 388/463 indicates 388 cases who were retransplanted and 463 cases who received only 1 transplant.
All were reversible. In group II, 50 of 58 immune reactions were reversible. 03) on clear and rejection-free graft survival. Discussion Many studies were performed within the past three decades considering the effects of HLA matching in penetrating keratoplasty. They delivered contradictory results [8–21]. In this study the beneficial effect of HLA class I plus II matching on clear and rejection-free graft survival after penetrating normal-risk keratoplasty could be demonstrated. 0 0 c 300 600 900 Days since kp 1,200 1,500 Fig.
Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36) by R. Sundmacher, F. Bandello