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 was once idea that adjunctive immunomodulating brokers may compensate. however the query of ways to deal with greater tolerance and more secure long term survival of corneal grafts after withdrawal of a effective immunomodulating protect nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and medical elements are mentioned via popular medical and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, in truth, a invaluable adjunct for long term survival of corneal grafts not just in these at excessive probability yet significantly additionally in sufferers at basic hazard. This quantity opens new pathways in the direction of the profitable program of HLA matching to keratoplasty surgeons, experimental and medical immunologists and cornea financial institution officials, while performing as an relief to ophthalmologists while discovering the foundation to thoroughly propose their keratoplasty sufferers.

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Additional resources for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)

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Goulmy E: Human minor histocompatibility antigens. Curr Opin Immunol 1996;8:75–81. Goulmy E, Pool J, Van Loghem E, Völker-Dieben HJ: The role of human minor histocompatibility antigens in graft failure. A mini review. Eye 1995;9:180–184. Streilein JW: Anterior chamber associated immune deviation: The privilege of immunity in the eye. Surv Ophthalmol 1990;35:67–73. Liew FY: Regulation of delayed-type hypersensitivity. VI. Antigen-specific suppressor T cells and suppressor factor for delayed-type hypersensitivity to histocompatibility antigens.

Inflammatory factors may induce the expression of HLA-DR molecules on the corneal endothelium [12, 55, 56]. Consequently, all recipients, especially the younger ones who obviously will have a longer period of exposure to such factors than elderly recipients, should also receive HLA matched grafts, irrespective of the degree of vascularization of their corneas at the time of transplantation. However, the implementation of such a policy is feasible only when there is an adequate supply of donor corneas for matching purposes.

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 [3] 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].

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