ABSTRACT
Our series comprised 100 penetrating corneal transplantations: 36 cases with HLA-B 12 and/or B 27 antigen in the recipient and, as controls, 64 cases without these antigens. The cornea was vascular in 44% of the HLA-B 12/B 27 group and in 40% of the controls. In the HLA-B 12/B 27 group AR developed in 13 of 36 cases, 36%; but in the control group only in one case (2%). In vascular and avascular cases the incidence of AR was equal. Among the high-risk cases of the HLA-B 12/B 27 group with definite mismatching of B 12 or B 27 antigens, 9 of the 14 recipients had developed AR. Six further recipients of this group had untyped grafts, and AR occurred in 4 of the 6, but in none of the 16 cases that were matched for B 12 or B 27 antigens. The value of a compatible graft, at least to the carriers of HLA-B 12 and/or B 27 antigens, is thus confirmed.
Subject(s)
Corneal Transplantation , Graft Rejection , HLA Antigens , Adolescent , Adult , Aged , Child , Cornea/blood supply , Female , Histocompatibility Testing , Humans , Male , Middle Aged , Transplantation, HomologousABSTRACT
HLA-B12 and HLA-B27 appeared to be characteristic of avascular keratoconus patients at risk of developing a corneal allograft reaction, which was mainly of late type and triggered by a nasopharyngeal infection. Equally incompatible grafts to patients with HLA-B5 had an uneventful course. This may be inference to the role of HLA-associated immune resistance factors, which necessitate the search for histocompatible corneal grafts also for avascular recipients bearing such indicators of risk.
Subject(s)
Corneal Transplantation , HLA Antigens , Histocompatibility Antigens , Keratoconus/surgery , Postoperative Complications , Cornea/immunology , Graft vs Host Reaction , Humans , Keratoconus/immunology , Phenotype , Risk , Transplantation, HomologousABSTRACT
Our series comprises 80 penetrating grafts. Of the recipient corneas 36 were vascularized. Of the donor corneas 48 were fresh and 32 were cryopreserved. As prophylaxis, we gave topical and systemic prednisolone, combined, in heavily vascularized cases, with azathioprine. Corneal donor-recipient pairs were divided into three groups according to HLA histocompatibility. In Group I (0-1 mismatch) the rate of allograft reaction was 1 in 27, in Group II (2-4 mismatches) it was 4 in 19, and in the untyped Group III 9 in 34. Even when the prognosis was poor, a well-matched donor cornea (Group I) greatly improved the chances of success; when the corneal bed was vascularized, the well-matched donor corneas had a failure rate of 1 in 13, whereas in untyped pairs it was 7 in 18. The importance of possible presensitization is discussed.
Subject(s)
Histocompatibility Testing , Adolescent , Adult , Aged , Child , Female , HLA Antigens/analysis , Humans , Male , Middle Aged , Refrigeration , Tissue Donors , Tissue Preservation , Transplantation, HomologousABSTRACT
Shortage of corneal grafts is common in many countries. The method presented here has been developed to relieve this situation and make it easier, especially from the psychological point of view, to obtain a license for excising corneas from cadavers. An 11 mm. corneal button is excised from the donor eye in situ with a Draeger electric rotor trephine and the donor eyes remain apparently normal looking. These excised corneas without sclerocorneal rims are placed in adequate without sclerocorneal rims are placed in adequate storage media for long-term cryopreservation according to Capella, Kaufman, and Robbins or for short-term storage according to McCarey and Kaufman. The preliminary results are promising and the technique seems not to be too delicate or complicated to be carried out by an experienced eye bank technician. It has improved our possibilities for storing donor corneas and for collecting many tissue-typed corneas in our eye bank.