The changing face of corneal graft rejection

Faraj, Lana A; Hashmani, Khurram; Khatib, Tasneem; Al-Aqaba, Mouhamed; Dua, Harminder S.

doi:10.1136/bjophthalmol-2012-301828

Cited by 19 publications

(13 citation statements)

References 22 publications

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“…Deep anterior lamellar keratoplasty, where only stroma and epithelium are replaced, 50 boasts a 10-year stable graft survival rate of 99.3% with a small loss in endothelial cell density (11%). 140 Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK) allow selective removal of the diseased Descemet membrane and endothelium.…”

Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

“…Currently, more than 100,000 corneal transplantations are carried out annually worldwide 50 for various conditions such as keratoconus, bullous keratopathy, failed previous graft, and corneal scarring, dystrophies, or infections. 159 …”

Section: Introductionmentioning

confidence: 99%

“…50,109 Despite advances in corneal surgery, optimal outcome is not achieved in all cases. This necessitates a better understanding of risk factors of the graft failure and the measures that can prevent such an outcome.…”

Section: Introductionmentioning

confidence: 99%

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Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

120

102

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The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal graft has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates due to a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered. However, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been employed for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments as well as tolerance-inducing methods show promising horizons in the management of high-risk corneal transplantation in near future.

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Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

120

102

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“…A preferred procedure for stromal diseases with a healthy endothelium is a technique called deep anterior lamellar keratoplasty (DALK), where the stroma and epithelium are replaced leaving the host endothelium intact [2]. DALK boasts a 10-year stable graft survival rate of 99.3% with an 11% loss in endothelial cell density from pre-operative levels [130].…”

Section: Corneal Allograft Rejectionmentioning

confidence: 99%

“…Corneal transplantation is among the most prevalent and successful organ transplants performed worldwide [1] with more than 65,000 corneas transplanted annually [2]. An overwhelming majority of these surgeries are performed in the United States, summing to 46,684 procedures in 2012 alone [3].…”

Section: Introductionmentioning

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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