Beneficial effects of histocompatibility in high-risk corneal transplantation

Forty-six consecutive patients at high risk for corneal graft rejection because of significant vascularization or previous graft rejection received transplanted corneas from donors who were selected on the basis of a negative lymphocyte crossmatch, ABO antigen blood group compatibility, and maximized HLA-A and HLA-B antigen matching. Graft survival in this study group was compared to that in a retrospective control group of 71 consecutive high-risk transplants performed in patients receiving corneas obtained randomly. We found no differences between groups in terms of demographic factors, cause of primary corneal disease, or the incidence of previous graft rejection. However, graft survival in the control group was only 49% (35 of 71) vs 83% (38 of 46) for the study group (P less than .001) with mean follow-up times of 29.6 and 15.5 months, respectively. All graft failures in the study group were in recipients with poorly matched HLA antigens. Patients with evidence of humoral presensitization to HLA antigen had twice the rejection rate of unsensitized recipients (three of 11 vs five of 35).