Histocompatibility testing for keratoplasty in high-risk patients

Area of Science:

• Ophthalmology
• Immunology
• Transplantation Science

Background:

• Corneal graft rejection remains a significant challenge, particularly in high-risk patients.
• Traditional donor selection methods may not adequately mitigate rejection risk.

Purpose of the Study:

• To evaluate the impact of prospective histocompatibility testing on corneal allograft survival in high-risk recipients.
• To compare graft survival rates between patients receiving crossmatch-selected donors and those receiving randomly selected donors.

Main Methods:

• A study group of 48 high-risk patients received corneal transplants from donors selected via negative lymphocyte crossmatch, ABO compatibility, and maximized HLA-A, -B matching.
• A retrospective control group of 72 high-risk patients received corneal transplants from randomly selected donors.
• Graft survival was analyzed using the Kaplan-Meier method.

Main Results:

• One-year graft survival was 78% in the prospective testing group versus 52% in the control group (P < 0.05).
• Graft failures in the prospective group occurred primarily in recipients with poor HLA matching.
• Nonspecific humoral presensitization did not significantly impact overall graft survival.

Conclusions:

• Prospective histocompatibility testing, specifically negative crossmatch and HLA matching, improves corneal allograft survival in high-risk patients.
• Optimizing donor selection through immunological matching is crucial for successful corneal transplantation.
• This strategy enhances the identification of suitable donors, leading to better patient outcomes.