HLA matching and corneal grafting.

Area of Science:

• Ophthalmology
• Immunology
• Transplantation Science

Background:

• Corneal transplantation success is influenced by various factors, including patient corneal vascularization and donor-recipient tissue compatibility.
• Human Leukocyte Antigen (HLA) and ABO blood group systems are key considerations in transplantation immunology.
• Graft rejection remains a significant challenge in corneal allografts, particularly in high-risk recipients.

Purpose of the Study:

• To investigate the impact of Human Leukocyte Antigen (HLA) and ABO incompatibility on the prognosis of full-thickness corneal allografts.
• To determine the association between pre-existing corneal vascularization and graft survival rates.
• To establish guidelines for optimizing corneal graft outcomes in patients with vascularized corneas.

Main Methods:

• A retrospective analysis of 200 full-thickness corneal allografts was conducted.
• Graft survival rates were assessed at one year post-transplantation.
• The influence of patient corneal vascularization, HLA antigen matching, and ABO compatibility on graft prognosis was evaluated.

Main Results:

• Graft survival at one year was significantly higher in patients with avascular corneas (85%) compared to those with severely vascularized corneas (33%).
• Severe corneal vascularization was strongly associated with irreversible graft rejection.
• Graft survival rates improved with increased HLA antigen matching; 2-HLA matched grafts had a 26% rejection rate versus 57-62% for 0-1 HLA matched grafts.
• ABO incompatibility did not affect graft prognosis.

Conclusions:

• HLA-matched corneal grafts are recommended for patients with severely vascularized corneas to improve graft survival.
• The findings support the establishment of HLA-typed cornea banks for high-risk corneal transplant recipients.
• Minimizing HLA mismatch is a critical strategy for preventing irreversible graft rejection in corneal transplantation.