By R. Sundmacher, F. Bandello
‘Immunologic privilege’ of the cornea and anterior chamber has, normally, been believed to be a adequate warrantly for survival of the donor cornea. If this failed, it was once proposal that adjunctive immunomodulating brokers may compensate. however the query of ways to take care of larger 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 medical points are mentioned by means of well known medical and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, in reality, a worthwhile adjunct for long term survival of corneal grafts not just in these at excessive chance yet significantly additionally in sufferers at common threat. This quantity opens new pathways in the direction of the winning software of HLA matching to keratoplasty surgeons, experimental and medical immunologists and cornea financial institution officials, whilst performing as an relief to ophthalmologists whilst discovering the root to appropriately suggest their keratoplasty sufferers.
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Extra resources for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)
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 . Materials and Methods Patients, HLA typings and their quality control, HLA-A, -B and -DR matching of recipients and donors, population genetics validation of HLA typing results, storage and quality control of donor corneas, clinical diagnostic criteria of graft rejection, post-operative follow-up and therapy, and data handling and statistical methods have been described previously.
Arch Ophthalmol 1992;110: 1392. Gore SM, Vail A, Bradley BA, Rogers CA, Easty DL, Armitage WJ: HLA-DR matching in corneal transplantation. Systematic review of published data. Transplantation 1995;60:1033. Bradley BA, Gore SM, Rogers CA, Armitage WJ, Easty DL: Negative effect of HLA-DR matching on corneal rejection. Transplant Proc 1995;27:1392. Vail A, Gore SM, Bradley BA, Easty Dl, Rogers CA, Armitage WJ: Conclusions of the corneal transplant follow-up study. Br J Ophthalmol 1997;81:631. Batchelor JR, Casey TA, Gibbs DC, Lloyd DF, Werb A, Prasad SS, James A: HLA matching and corneal grafting.
032 71/89 58/75 71/85 54/74 66/76 851/830 207/642 214/066 144/707 436/415 mism ϭ Mismatches; p value ϭ significance of the difference between the 2 curves. a Cases: For vascularization, 851/830 indicates 851 high-risk cases and 830 low-risk cases. A similar interpretation should be used for the cases listed for the other factors. b No selection for vascularization risk status. All cases analyzed. Joint Effect of HLA-A, -B and -DR Matching The hypothesis for a joint effect of HLA-A, -B and -DR matching was supported by the fact that, among the 553 cases that were typed for those three loci, 7 grafts with 0 DR mismatches but 1 or 2 AB mismatches failed and 8 grafts with 0 AB mismatches but 1 DR mismatch failed.
Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36) by R. Sundmacher, F. Bandello