Cincinnati Protocol for Preoperative Screening and Donor Selection for Ocular Surface Stem Cell Transplantation

Area of Science:

• Ophthalmology
• Immunology
• Transplantation Science

Background:

• Ocular surface stem cell deficiency requires transplantation for visual restoration.
• Effective donor selection is critical to minimize graft rejection and improve outcomes.
• Preoperative screening protocols guide the identification of suitable donors.

Purpose of the Study:

• To detail the established protocol for preoperative screening and donor selection in ocular surface stem cell transplantation (OSST).
• To evaluate the effectiveness of the screening process in identifying optimal donor-recipient matches.
• To ensure minimized antigenic burden on transplanted ocular tissues.

Main Methods:

• Retrospective chart review of patients undergoing OSST over seven years.
• Inclusion criteria: patients with limbal stem cell deficiency receiving OSST; exclusion: autografts for unilateral disease.
• Data collected included human leukocyte antigen (HLA) typing, virtual crossmatching, donor-specific antibodies, and panel reactive antibody levels.

Main Results:

• Of 142 eyes (104 patients), 94 donors were tested for 67 recipients.
• Seventy-three ABO-compatible matches were found for 61 recipients; 5 patients had positive virtual crossmatches.
• The majority of successful matches involved siblings (65%), followed by parents (30%).

Conclusions:

• The developed protocol effectively screens donors for ocular surface stem cell transplantation.
• Selection of the best available donor match significantly reduces the antigenic load.
• This approach enhances the potential for successful engraftment and visual recovery.