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Reduced graft rejection with good HLA-A and B matching in high-risk corneal transplantation
Insights
Matching human leukocyte antigen (HLA)-A and B in corneal transplantation significantly reduces graft rejection in high-risk patients. Better HLA matching improves long-term corneal graft survival and lowers rejection episodes.
Area of Science:
- Immunogenetics
- Ophthalmology
- Transplantation immunology
Background:
- Corneal transplantation is a common procedure, but high-risk recipients often face graft rejection.
- Prior graft rejection or severe corneal vascularization increases the risk of transplant failure.
Purpose of the Study:
- To investigate the impact of human leukocyte antigen (HLA)-A and B matching on corneal graft success in high-risk patients.
- To determine if improved HLA matching reduces graft rejection rates and enhances long-term graft survival.
Main Methods:
- Prospective, masked, single-center study involving 97 high-risk corneal transplant recipients.
- Donor corneas selected for ABO compatibility, negative lymphocyte crossmatch, and optimal HLA-A and B matching.
- Patients were stratified into good (≥2 antigens) and poor (<2 antigens) HLA-A and B match groups.
Main Results:
- Graft rejection occurred in 21% of patients with a good HLA match versus 49% with a poor match (P<0.010).
- Rejection-free graft survival at two years was 80.1% for good matches vs. 38.5% for poor matches.
- Poor HLA-A and B matching was associated with a 4.6-fold increased risk of rejection and 11.2-fold increased risk of irreversible rejection.
Conclusions:
- Good HLA-A and B matching significantly improves long-term corneal graft survival in high-risk recipients.
- HLA matching is a critical factor in reducing graft rejection episodes and subsequent graft failure.
- These findings support the routine use of HLA-A and B matching for high-risk corneal transplant candidates.
Abstract:
We examined the effect of matching for HLA-A and B antigens on the success of corneal transplantation in a single-center, prospective, masked study that began in March 1979. The study involved 97 consecutive recipients at high risk because of prior corneal graft rejection or serious vascularization of the native cornea. Donor corneas were selected on the basis of ABO-blood-group compatibility, a negative lymphocyte crossmatch, and optimal HLA-A and B matching; all clinical personnel were "masked" to the degree of HLA matching during the study. Among 38 patients receiving corneas with a good HLA match (two or more antigens), only 8 (21 percent) had graft rejection, as compared with 29 of 59 (49 percent) with a poor match (no or one antigen) (P less than 0.010). The mean (+/- SE) difference in rejection-free graft survival increased with time: 88.4 +/- 5.5 percent versus 73.5 +/- 5.9 percent at six months, and 80.1 +/- 7.5 percent versus 38.5 +/- 7.9 percent at two years. Cox multiple regression analysis, which included the HLA-A and B match and nine other potential confounding variables and risk factors also identified a significant (P less than 0.009) relative risk (4.6) of rejection reactions as well as irreversible graft rejection (P less than 0.016; relative risk, 11.2) with poor HLA-A and B matching. Our findings indicate that good HLA-A and B matching yields a significant long-term benefit in reducing the number of episodes of graft rejection and subsequent failure in high-risk recipients of corneal transplants.