By R. Sundmacher, F. Bandello
‘Immunologic privilege’ of the cornea and anterior chamber has, in general, been believed to be a adequate warrantly for survival of the donor cornea. If this failed, it used to be concept that adjunctive immunomodulating brokers could compensate. however the query of the way to deal with larger tolerance and more secure long term survival of corneal grafts after withdrawal of a effective immunomodulating guard nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and medical elements 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 truth, a worthy adjunct for long term survival of corneal grafts not just in these at excessive possibility yet particularly additionally in sufferers at common 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, whilst appearing as an reduction to ophthalmologists while discovering the foundation to properly propose their keratoplasty sufferers.
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Additional info for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)
32). The second analysis used the time to any immunological rejection event, reversible or irreversible, as the entry time. 0004 Non-immunological failures excluded 20 10 0 0 6 12 18 24 30 36 42 48 54 60 Months after corneal transplantation Fig. 3. Influence of HLA-AB matching on high-risk corneal transplants. All immunological rejections, reversible or irreversible, were analyzed. High-risk recipients are those with moderate or severe pre-operative corneal vascularization in 2 or more quadrants.
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 . This examination was proven to deliver reproducible results .
LCs are found in the peripheral region of the corneal epithelium. Those cells or their precursors are the only epidermal cells expressing HLA class II antigens or their equivalents . HLA-DR-positive LCs are found in the central corneal epithelium of rejected transplants and in herpetic corneas. They are found only in the limbus of healthy corneas [8, 51]. Donor corneas that are stored for 14 days in organ culture are negative for HLA-DR-positive LCs . The higher proportion of transplant rejection episodes in larger grafts than in smaller ones (tables 1, 2) may be attributed to the presence of LCs that express HLA class I and II antigens.