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Impressum
Predicted time on the waiting list for HLA-matched corneal grafts*
1Böhringer D., 1Reinhard T., 2Enczmann J., 2Wernet P., 1Sundmacher R.
1Eye Hospital, Heinrich-Heine University and LIONS Cornea Bank NRW, 2Bone Marrow Donor Center and Institute for Transplantation Immunology, Düsseldorf
Objective: Recent evidence proves that graft survival in low-risk
as well as in high risk keratoplasty (kp) can be improved by HLA- class
I and II matching. Improved prognosis, however, has to be weighted against
the additional time on the waiting list due to the search for a well matched
graft. Precise advance knowledge about this additional time on the waiting
list when searching for a well matched graft is a prerequisite for informed
consent on the waiting policy.
Methods: The total share of suitable donors for a given patient
and match grade (0 to 6 mismatches on HLA-A/ -B/ -DR) is calculable from
a database of the 1516 most common three-locus HLA-haplotype gene-frequencies
in the German population. A mathematical model derived from survival analysis
was used to calculate estimated time on the waiting list from the above
total share of suitable donors. Additionally, the time each patient would
have been waiting for a match at the Lions cornea bank NRW was retrospectively
determined. Both values were tested for correlation. This analysis was
performed for acceptance two to zero mismatches on HLA-A/ -B/ -DR.
Results: When accepting two, one and zero mismatches at HLA -A/-B/-DR
for 1131 (83%), 971 (71%) and 398 (29%) patients a match would have been
found. Median predicted waiting time was 9±11, 11±11 and
19±13 respectively. Median retrospectively determined waiting time
was 7±10, 9±9 and 18±14 months. Both values were
correlated statistically significant (p<0.0001).
Conclusion: The predicted time on the waiting list as derived from
the patient's HLA-diplotype and a comprehensive database of three-locus
HLAhaplotypes is a valuable tool for managing HLA-matching in kp. When
two mismatches are accepted, waiting for a match seems logistically reasonable
even in low-risk kp. This should be discussed with each patient individually.
*Supported by Eurotransplant/BIS Leiden (NL)