1Reinhard T., 1Böhringer D., 2Enczmann J., 2Kögler G., 2Wernet P., 1Sundmacher R.

1Eye Hospital and LIONS Cornea Bank NRW, 2Institute for Transplantation Immunology, Heinrich-Heine University, Düsseldorf

Objective: Due to contradictory results, HLA-matching in penetrating keratoplasty still is equivocal. In this study the value of HLA-matching was examined in a very homogenous group of 418 normal-risk keratoplasty patients.
Methods: In a monocenter study penetrating normal-risk keratoplasty was performed in 5 groups of patients (group I with 0-2, group II with 3, group III with 4, group IV with 5 and group V with 6 mismatches in the A/B/DR loci). All surgery was done by 3 experienced surgeons according to a standardized scheme. All HLA-typing was performed in a quality controlled laboratory, serologically für HLA class I (A and B locus) and moleculargenetically for HLA class II (DR locus).
Results: Four years postoperatively, the ratio of clear and rejection-free graft survival was 92% in I, 78% in II, 69% in III, 79% in IV and 73% in V (Kaplan Meier estimation, log rank test, p<0,05). Monovariate analysis in the Cox model gave no influence of HLA class I or II matching (p>0.05), but only an influence of combined HLA class I and II matching (p<0.05). An influence of patient age, patient gender, intraocular procedures, triple procedures, preceeding, donor age, donor gender, time of the graft in organ culture, post mortem time of the graft or endothelial cell density at the end of the culture period on this result could be excluded.
Conclusions: In a very homogenous group of normal-risk keratoplasty patients the beneficial effect of HLA class I and II matching on clear and rejection-free graft survival could be demonstrated if at most 2/6 mismatches are accepted.

*Supported by Bio Implant Services, Leiden, NL

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