By R. Sundmacher, F. Bandello
‘Immunologic privilege’ of the cornea and anterior chamber has, mostly, been believed to be a adequate warrantly for survival of the donor cornea. If this failed, it used to be idea that adjunctive immunomodulating brokers might compensate. however the query of ways to take care of greater tolerance and more secure long term survival of corneal grafts after withdrawal of a powerful immunomodulating defend nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and scientific elements are mentioned via popular medical and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, in truth, a beneficial adjunct for long term survival of corneal grafts not just in these at excessive hazard yet significantly additionally in sufferers at basic threat. This quantity opens new pathways in the direction of the profitable software of HLA matching to keratoplasty surgeons, experimental and medical immunologists and cornea financial institution officials, whilst performing as an relief to ophthalmologists while discovering the root to correctly suggest their keratoplasty sufferers.
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Extra resources for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)
One week later, an anti-HLA-A2 antibody was detected in his serum. That case is a good example of a normal immune response to an HLA histoincompatibility in an elderly corneal transplant recipient . The significant beneficial effect of HLA-A, -B and -DR typing and matching on the survival of high-risk corneal transplants justifies that practice for all high-risk recipients of corneal transplants. The joint effect of HLA-A, -B and -DR matching which we and others have found suggests that attempts must be made to minimize the number of mismatches by typing and matching recipients and donors for the antigens at those 3 loci.
Pels L, Maas H, Tullo A: European Eye Bank Association Directory, ed 8, 2000. Böhnke M: Spendergewebe für die Keratoplastik. Klin Monatsbl Augenheilkd 1991;198:563–571. Reinhard T, Holzwarth D, Spelsberg H, Dahmen N, Sundmacher R: Wissensbasierte Bildanalyse von Hornhauttransplantaten. Klin Monatsbl Augenheilkd 1999;214:407–411. Hoffmann F: Nahttechnik bei perforierender Keratoplastik. Klin Monatsbl Augenheilkd 1976; 169:584–590. Allredge OC, Krachmer JH: Clinical types of corneal transplant reaction.
Newsome et al.  demonstrated the presence of class I antigens on epithelial, stromal and endothelial corneal cells. In contrast, class II antigens are regularly expressed only on epithelial Langerhans’ cells . After incubation with interferon-␥, however, class II antigens are expressed on all corneal cells including the endothelium [30, 31]. CD4 T cells are the main source of interferon-␥ . In the rat-penetrating keratoplasty model, CD4 T cells were found even in syngeneic grafts .
Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36) by R. Sundmacher, F. Bandello