Abstract

DO.18.05

Functional antigen matching in penetrating keratoplasty

Böhringer D., Reinhard T.
University Eye Hospital Freiburg, Germany

Objective: Immune reactions are the major complication in penetrating keratoplasty. Perfect primary prophylaxis is only obtainable from avoidance of all 'foreign' graft antigens as in monocygotous or autologous grafts. This strategy is generally not feasible due to the genetic heterogenicity. Not all genetic differences contribute equally to antigenicity, though. The respective roles of major (HLA) and minor (H) histocompatibility antigens in penetrating keratoplasty are subject to controversial discussion.
Methods: We will discuss the current evidence on HLA and H matching in clinical penetrating keratoplasty. We will address practical concerns on the high variability of waiting times in HLA matching. A special focus will be on HLAMatchmaker. This method allows for predicting HLA mismatches of subordinate antigenicity from the recipient's HLA phenotype. Recent data suggests, that this procedure is additionally promising in repeat keratoplasties, when the rejected HLA phenotype is known.
Conclusions: Histocompatibility has the strong potential to improving the overall outcome in penetrating keratoplasty. Further advocacy for histocompatibility will most likely come from randomized clinical trials and profound cost-effectiveness analyses in the not so far future.

Copyright: Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.