By R. Sundmacher, F. Bandello
‘Immunologic privilege’ of the cornea and anterior chamber has, quite often, been believed to be a enough 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 the way to deal with larger 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 features are mentioned via well known scientific and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, actually, a invaluable adjunct for long term survival of corneal grafts not just in these at excessive possibility yet particularly additionally in sufferers at common probability. This quantity opens new pathways in the direction of the profitable program of HLA matching to keratoplasty surgeons, experimental and scientific immunologists and cornea financial institution officials, even as performing as an reduction to ophthalmologists whilst discovering the foundation to safely suggest their keratoplasty sufferers.
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Extra resources for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)
Systemic corticosteroids were administered for only 3 weeks postoperatively. Acetazolamide was administered in a daily dose of 500 mg for 5 days Reinhard/Böhringer/Enczmann/Kögler/Mayweg/Wernet/Sundmacher 44 postoperatively. Controls of the graft at the slitlamp were scheduled 6 weeks, 4, 12 and 18 months postoperatively and thereafter annually. Immune Reactions Endothelial immune reactions were diagnosed via endothelial precipitates and stromal edema, stromal immune reactions via nummular infiltrates without preceding infectious (adenoviral) background .
E. excluded, from the analyses. Survival curves were calculated using the actuarial life table method . The significance of differences between classes was assessed with a 2 statistic derived from a log-rank test . Relative risk (RR) estimates were derived from the values in the logrank tables. The absence of any rejection episode, reversible or irreversible, is a more sensitive and appropriate indicator of the immune competence of corneal transplant recipients than the time to irreversible immunological rejection that is really an indication of the efficacy of follow-up procedures, especially the immunosuppressive therapy protocols, of transplantation centers.
Those factors also stimulate the migration and accumulation of antigen-presenting Langerhans’ cells (LCs) in the corneal epithelium that lead to the activation of T cells and subsequent transplant rejection [53, 54] and the appearance of lymphatic vessels. The induction of LCs and lymphatics, rather than the presence of blood vessels, may be the crucial factors responsible for abolishing the immune privilege of the corneal graft bed. Histocompatibility and Corneal Transplantation 37 Mismatched HLA class I antigens (HLA-A and -B) are believed to be the main targets for cytotoxic T lymphocytes and alloantibodies.