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Impressum
Beneficial Effect of HLA-DR Matching on the Survival of Corneal Allografts
1Völker-Dieben H. J., 2Claas F. H., 2Schreuder G. M., 3Schipper R.
F., 4Pels E.,
5Persijn G. G., 5Smits J., 1D'Amaro J.
1Department of Ophthalmology, Vrije Universiteit, Amsterdam; 2Department
of
Immunohematology & Blood Bank, Leiden; 3College voor Zorgverzekeringen,
Amstelveen; 4The Netherlands Ophthalmic Research Institute, Amsterdam;
5The Eurotransplant Foundation, Leiden
Background: Although HLA typing and matching have been used for
3 decades, that practice has been poorly implemented in corneal transplantation,
mainly because of inconclusive or contradictory analytical results. Consequently,
we studied the immune response of corneal transplant recipients to HLA
histoincompatibilities in a large homogeneous population.
Methods: All corneal transplants performed by a single surgeon
between 1976 and 1996 were studied. HLA-AB matching was used for recipient
selection. All HLA typings were performed by a single experienced laboratory.
Population genetic techniques were used to assess the validity of the
HLA typings. Monoand multivariate analyses were performed to identify
the factors which significantly influence the survival of corneal allografts.
Simulation studies were carried out to demonstrate the effect of mis-typed
donor and recipient HLA-DR typings on analytical results.
Results: Retransplantation, degree of vascularization, HLA-AB and
DR matching, endothelial cell count, graft size, recipient gender, and
storage method were identified as significant factors by our monovariate
analyses. A Cox proportional hazards survival analysis model identified
degree of vascularization and HLA-AB and DR matching as significant prognostic
factors when all immunological rejection episodes were used, P=0.000001.
When only irreversible immunological episodes were used, panel reactive
antibodies, retransplantation, and number of rejection events were also
identified, P=0.000001. Simulation studies showed that the effects
of HLA-DR matching are abrogated by poor HLA-DR typings.
Conclusions: Corneal allograft recipients have a normal alloimmune
response to histoincompatibilities. Demonstration of that fact requires
accurate HLA typings.