High-risk Corneal Transplantation: Recent Developments and Future Possibilities.

Area of Science:

• Ophthalmology
• Immunology
• Transplantation Science

Background:

• Corneal transplantation (keratoplasty) is often considered successful due to immune privilege.
• However, significant rates of rejection and graft failure occur, comparable to solid organ transplants.
• The immunological basis for these failures, especially in high-risk cases, requires further elucidation.

Purpose of the Study:

• To review current clinical and basic science insights into high-risk keratoplasty.
• To identify factors contributing to corneal graft failure and their immunological underpinnings.
• To highlight research priorities for enhancing long-term corneal allograft survival.

Main Methods:

• Review of recent clinical and basic science literature on corneal transplantation.
• Analysis of factors associated with corneal graft failure.
• Discussion of immunological mechanisms in corneal allograft rejection.

Main Results:

• Identified risk factors for corneal transplant failure, with unclear contribution from immune-mediated rejection.
• Highlighted the need for improved predictive risk scores and assays.
• Emphasized the potential of multicenter trials and novel immunomodulatory/regenerative therapies.

Conclusions:

• Further research into predictive tools, optimized immunosuppression, and novel therapies is crucial for high-risk corneal transplants.
• Understanding the immunology of rejection is key to improving graft survival.
• More knowledge is needed on outcomes for infection-related corneal diseases, particularly in developing nations.