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Rejection Prophylaxis in Corneal Transplant.

Daniel Böhringer1, Birgit Grotejohann, Gabriele Ihorst

  • 1* The members of the FANCY Study Group are listed at the end of this article; Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ADMEDICO Augenzentrum Olten, Switzerland; Laboratory for Translational Immunology, University Medical Center Utrecht, The Netherlands.

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Human leukocyte antigen (HLA) matching did not significantly reduce corneal transplant rejection in the FANCY trial. The study found no clear benefit of HLA matching over random assignment for graft survival.

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Area of Science:

  • Ophthalmology
  • Transplantation Immunology

Background:

  • Corneal transplant rejection affects 20-30% of patients within 5 years.
  • Prophylaxis using human leukocyte antigen (HLA) matching is debated.
  • The Functional ANtigen matChing in keratoplastY (FANCY) trial investigated HLA matching's efficacy.

Purpose of the Study:

  • To evaluate if HLA matching is superior to random graft assignment in preventing corneal transplant rejection.
  • To determine the effect of HLA matching on rejection-free graft survival in both normal-risk and high-risk patients.

Main Methods:

  • A randomized, double-blind, multicenter clinical trial (FANCY).
  • Compared HLA matching against random graft assignment for corneal transplantation.
  • Primary endpoint: rejection-free graft survival over two years.

Main Results:

  • 721 patients were included; 639 were randomized.
  • 33 rejections in the HLA matching arm (15.7% cumulative incidence at 2 years).
  • 40 rejections in the control arm (17% cumulative incidence at 2 years).

Conclusions:

  • HLA matching showed no significant advantage over random graft assignment in this heterogeneous study group.
  • Observed rejection rates were lower than anticipated, limiting definitive conclusions.
  • Further research may be needed to establish the benefit of HLA matching in corneal transplantation.