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Beneficial Effect of HLA-matching on the Outcome of Corneal Grafts
Khaireddin R., Wachtlin J., Hoffmann F.,
Freie Universität Berlin, Klinikum Benjamin Franklin, Augenklinik (Berlin)
Purpose: HLA typing and matching have been practised in transplantation medicine for more than thirty years. However, its use in corneal transplantation is still a matter of ongoing debate.
Methods: In the years 1983 to 2001, 492 patients have received a perforating corneal transplantation in our clinic. 330 of those patients were currently used in this study. In all cases we performed a HLA typing for A, B and DR loci and HLA-A, B and DR matching was used for recipient selection. Patients were split into two groups (good or bad prognosis), depending on their preoperative diagnosis.
Results: 329 postoperative transparent grafts are discussed here. An allograft rejection was observable in 30 out of 221 patients (14%) for patients grouped as good prognosis. Patients predicted to have a bad prognosis showed 53 cases of an allograft rejection out of 108 patients (49%). Using Kaplan-Meier Survival Analysis we have shown a significant correlation (p=0.0009) between the number of HLA mismatches and the quantity of allograft rejections, especially in patients with a bad prognosis. Patients with good prognosis show a slight correlation between HLA mismatches and allograft rejections, however, this is not significant (p=0.1763). Furthermore we could demonstrate, that especially HLA-B mismatches are significant prognosis factors (p=0.0007) for patients with a bad prognosis. Combining of HLA B and DR mismatches shows a similar tendency of allograft rejection (p=0.0689).
Conclusions: The clinical results confirm the theoretical predictions about the function of the HLA (MHC) receptor. The closest possible match of the HLA antigens between the donor and the recipient improves the prognosis for the long term transparency of the corneal graft.