[At-risk keratoplasty, HLA antigens and cyclosporin A]

Keratoplasty in a calm and avascular cornea usually involves no histocompatibility problem. This is not the case if the recipient cornea is inflamed or vascularized. In such cases, and in those where the donor button has been rejected, HLA matching and particularly the search of HLA DR is important. More than 80 potential kidney donors (160 eyes) are tested each year at Zurich University Hospital. The availability of matched corneas, a certain degree of homogeneity of DR group in our population, and an "anti-DR" action of cyclosporin-A gave us the incentive to perform this study and to place these corneas at the disposal of every Swiss clinic. For this purpose, the HLA groups of high-risk patients must be established and sent to Zurich Eye Bank where these data are regularly compared with matched corneas. Every time an HLA A, B, and especially an HLA DR compatible donor-recipient pair occurs, the clinic involved will be quickly informed. In cases where HLA DR antigens are not compatible, cyclosporin-A should be part of the treatment and in cases where they are compatible, advice would be given to do without it. Since optimal preservation, with the medium used lasts 5 days, there is sufficient time for most corneas with a known HLA group to be grafted on the most compatible recipient.