By R. Sundmacher, F. Bandello
‘Immunologic privilege’ of the cornea and anterior chamber has, mostly, been believed to be a adequate warrantly for survival of the donor cornea. If this failed, it was once notion that adjunctive immunomodulating brokers could compensate. however the query of ways to deal with higher tolerance and more secure long term survival of corneal grafts after withdrawal of a effective immunomodulating defend nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and scientific facets are mentioned by way of well known scientific and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, in reality, a worthy adjunct for long term survival of corneal grafts not just in these at excessive hazard yet significantly additionally in sufferers at basic danger. 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, even as appearing as an reduction to ophthalmologists whilst discovering the foundation to safely propose their keratoplasty sufferers.
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Additional info for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)
They retyped 129 patients with less than 2 DR antigens. The concordance between the original and retypings was 55% for HLA-DR, and it rose to 59% when they excluded the antigens that were difficult to type. The most common error that they identified was the failure to identify a second DR locus antigen. The total magnitude of typing errors in their study is unknown, since none of the remaining patients and none of the donors were retyped. However, our simulation studies, which introduced similar HLA-DR typing errors into our 280 well-typed patient and donor HLA-DR typings, showed that even small amounts of imprecise HLA-DR typings, as little as 5% can abrogate the true beneficial effect of HLA-DR matching on the survival of corneal transplants and that larger amounts of imprecise typings can lead to an apparent adverse effect of HLA-DR matching as shown in the results of the CCTS study  and Völker-Dieben/Schreuder/Claas/Doxiadis/Schipper/Pels/Persijn/Smits/D’Amaro 36 in reports on the negative effect of HLA-DR matching on corneal graft rejection from the UK [16–18].
In subsequent years, knowledge of human leukocyte antigens has progressed to the state where many antigenic determinants controlled by multiple closely linked complex loci can be recognized by serologic and/or molecular techniques. Similar studies in other vertebrate species have demonstrated the presence of clusters of genes on a single chromosomal segment that control similar antigens and other immunologically interrelated functions. Those genes constitute the major histocompatibility complex (MHC) of the species.
Vannas S: Histocompatibility in corneal grafting. Invest Ophthalmol 1975;14:883–886. Stark WJ, Hugh RT, Bias WB, Maumenee AE: Histocompatibility (HLA) antigens and keratoplasty. Am J Ophthalmol 86:595–604. Reinhard/Böhringer/Enczmann/Kögler/Mayweg/Wernet/Sundmacher 48 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Ehlers N, Kissmeyer-Nielsen F: Corneal transplantation and HLA histocompatibility. Acta Ophthalmol 1979;57:738–741. Foulks GN, Sanfilippo FP, Locasio JA, MacQueen JM, Dawson DV: Histocompatibility testing for keratoplasty in high-risk patients.