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A. Pherwani, D. Raj, H. S. Dua; HLA Matching in High Risk Corneal Grafting. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5759.
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© ARVO (1962-2015); The Authors (2016-present)
To establish if HLA-A, B and DR tissue matching in high risk corneal graft is associated with a reduced risk of graft rejection and associated graft failure.
Forty consecutive patients who underwent HLA matched penetrating keratoplasty were included in the study. The 40 eyes were considered to be at a high risk of immune mediated graft rejection and failure due to previous failed grafts, corneal stromal vascularisation in more than 2 quadrants, previous history of chemical injury and herpes simplex keratitis infection leading to corneal scarring and vascularisation.The following data was collected retrospectively - indication for performing the HLA matched graft, number of rejection episodes and time to the 1st rejection episode, status of the graft at final follow up (clear or failed/edematous), systemic immunosuppression, visual acuity at final follow up and HLA mismatches at A, B and DR loci.
Thirty three grafts out of 40 (82.5%) remained clear at final follow up which ranged from 10-108 months. Seven grafts were deemed to have failed.The failed grafts had a total of 2 to 4 mismatches at the HLA- A, B and DR loci (3 had 2 mismatches, 3 had 3 and 1 had 4). In the 33 grafts that remained clear mismatches ranged from 1 to 4 (3 grafts had 1, 6 grafts had 2, 15 had 3 and 9 had 4 mismatches).On assessing the mismatches at the HLA-A and B loci, 1 failed graft had 1 mismatch and 5 had 2, whereas in the 33 clear grafts this ranged from 0 to 3 (2 grafts had 0, 4 had 1, 26 had 2 and 1 had 3 mismatches).At the DR loci, the mismatches in the failed grafts ranged from 0 to 2 (2 had 0 mismatches, 4 had 1 and 1 had 2 mismatches). In the successful grafts the mismatches at this loci ranged from 0 to 2 (5 grafts had 0 mismatches, 17 had 1, 11 had 2 mismatches).Thirty six patients had been on systemic suppression for at least 12 months. Six of these had a failed graft at final follow up. Of the 4 patients who did not receive systemic suppression, 1 had a failed graft.
HLA-A, B and DR matching appears to reduce the risk of graft rejection and failure in high risk grafts. However no conclusions can be drawn regarding the superiority of A and B loci matching over DR matching in reducing the risk of graft rejection and failure.
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