An adverse matching effect for the HLA-B locus in corneal transplantation

Hill, John C.; Creemers, Paula

doi:10.1007/s001470050029

Cited by 8 publications

(3 citation statements)

References 20 publications

(14 reference statements)

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“…These discrepancies may be due to the small number of patients discussed by the Japanese group. Thus, it is not surprising that our results demonstrating a favorable effect of HLA-DR matching on corneal allograft outcome in high-risk patients are in line with Volker-Dieben et al [43] and other studies [3,15] as well as the experimental findings on HLA class II receptor function. HLA-DR-positive Langerhans cells have been found in normal corneal epithelium and stromal layers [24,34], but only in the limbus of healthy corneas [35].…”

Section: Discussionsupporting

confidence: 93%

“…These data on HLA-A and -B matching are in keeping with the results from our study. However, our findings clearly differ from those obtained in other studies, particularly the large multicenter Collaborative Corneal Transplantation Study (CCTS), which failed to demonstrate a correlation between HLA matches and graft survival [9,12,15]. The CCTS authors drew the conclusion that neither HLA-A and -B nor HLA-DR antigen matching significantly reduces the incidence of corneal graft failure in high-risk patients under local immunosuppressive therapy.…”

Section: Discussioncontrasting

confidence: 84%

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HLA-A, HLA-B and HLA-DR matching reduces the rate of corneal allograft rejection

Khaireddin

Wachtlin

Hopfenmüller

et al. 2003

Graefe's Arch Clin Exp Ophthalmol

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 84%

HLA-A, HLA-B and HLA-DR matching reduces the rate of corneal allograft rejection

Khaireddin

Wachtlin

Hopfenmüller

et al. 2003

Graefe's Arch Clin Exp Ophthalmol

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“…HLA matching in a controlled setting among normal-risk patients demonstrated a clear advantage in ensuring clear and rejection-free corneas [24]. Despite the controversy regarding the therapeutic benefit of HLA matching in preventing corneal graft rejection [5,28], several reports suggest an association between HLA incompatibility and graft rejection, and consequently the advantage of HLA tissue typing especially in high-risk patients [28–32]. It has been shown that actively rejecting grafts are strongly associated with primed, donor HLA-class I-specific cytotoxic T cells, making a strong case in favor of HLA-A and –B typing for high-risk transplant patients [29,33–36].…”

Section: Mechanisms Of Corneal Graft Rejectionmentioning

confidence: 99%

Corneal Allograft Rejection: Immunopathogenesis to Therapeutics

Qazi

Hamrah²

2013

J Clin Cell Immunol

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Corneal transplantation is among the most successful solid organ transplants. However, despite low rejection rates of grafts in the ‘low-risk’ setting, rejection can be as high as 70% when grafted into ‘high-risk’ recipient beds. Under normal homeostatic conditions, the avascular cornea provides a unique environment that facilitates immune and angiogenic privilege. An imbalance in pro-inflammatory, angiogenic and lymphangiogenic mediators leads to a breakdown in corneal immune privilege with a consequent host response against the donor graft. Recent developments in lamellar and endothelial keratoplasties have reduced the rates of graft rejection even more, while providing improved visual outcomes. The corneal layer against which an immune response is initiated, largely determines reversibility of the acute episode. While epithelial and stromal graft rejection may be treated with topical corticosteroids with higher success, acute endothelial rejection mandates a more aggressive approach to therapy due to the lack of regenerative capacity of this layer. However, current immunosuppressive regimens come with the caveat of ocular and systemic side effects, making prolonged aggressive treatment undesirable. With the advent of biologics, efficacious therapies with a superior side effect profile are on the horizon. In our review we discuss the mediators of ocular immune privilege, the roles of cellular and molecular immune players in graft rejection, with a focus on human leukocyte antigen and antigen presenting cells. Furthermore, we discuss the clinical risk factors for graft rejection and compare rates of rejection in lamellar and endothelial keratoplasties to traditional penetrating keratoplasty. Lastly, we present the current and upcoming measures of therapeutic strategies to manage and treat graft rejection, including an overview of biologics and small molecule therapy.

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Gewebetypisierung bei der perforierenden Keratoplastik

2003

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The demand for matched corneal grafts has risen rapidly over the last years. One reason for this is the change in the judgement of the value of tissue and especially HLA typing for prevention of an immune reaction in perforating corneal transplantation. Besides HLA or major antigens, there are other immunologically relevant tissue surface molecules such as the non-MHC antigens of which blood groups and minor antigens are the most important. With regard to effective cost-benefit and waiting time-benefit analyses, differentiated matching strategies are needed to assure optimized utilization and allocation of the still unsatisfactory number of available corneal grafts. With special matching strategies, such as the calculation of the individual waiting time, the consideration of split, non-MHC and HLA antigens, additional HLA loci as well as so-called "permissible" and "taboo" mismatches, much more has to be taken into account in the future than just the numerical correspondence of HLA antigens. This will make it possible to turn from a pure numerical approach to a functional matching strategy. This review summarizes the discussion and different matching strategies, possibilities and limitations of HLA and tissue typing in perforating corneal transplantation.

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An adverse matching effect for the HLA-B locus in corneal transplantation

Cited by 8 publications

References 20 publications

HLA-A, HLA-B and HLA-DR matching reduces the rate of corneal allograft rejection

HLA-A, HLA-B and HLA-DR matching reduces the rate of corneal allograft rejection

Corneal Allograft Rejection: Immunopathogenesis to Therapeutics

Gewebetypisierung bei der perforierenden Keratoplastik

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