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Adequate HLA Matching in Keratoplasty (Developments in by R. Sundmacher, F. Bandello

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 was once inspiration that adjunctive immunomodulating brokers might compensate. however the query of the way to take care of greater tolerance and more secure long term survival of corneal grafts after withdrawal of a effective immunomodulating guard nonetheless remained unanswered. the answer's human leukocyte antigens (HLA) matching. during this quantity, immunological and scientific points are mentioned by means of well known medical and experimental immunologists in addition to skilled keratoplasty surgeons. those specialists finish that HLA matching is, actually, a beneficial adjunct for long term survival of corneal grafts not just in these at excessive hazard yet significantly additionally in sufferers at general chance. 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, whilst performing as an reduction to ophthalmologists while discovering the root to correctly propose their keratoplasty sufferers.

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Additional info for Adequate HLA Matching in Keratoplasty (Developments in Ophthalmology, 36)

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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-␥ [32]. In the rat-penetrating keratoplasty model, CD4 T cells were found even in syngeneic grafts [32]. Possibly, an elevation of interferon-␥ levels in the graft may already be caused by a surgical trauma such as penetrating (normal-risk) keratoplasty. The evolution in keratoplasty has been such that the early attempts to exploit the theoretical advantages of HLA matching had unavoidably too often been technically weak so that the probability of negative or questionable results was high.

Munksgaard, Copenhagen, 1972, pp 619–648. Batchelor JR, Morris PJ, Walford RL, Dumble L, Law W, Kirk R, Case J: Studies on HL-A in a Fijian population; in Dausset J, Colombani J (eds): Histocompatibility Testing 1972. Munksgaard, Copenhagen, 1972, p 283. Goulmy E: Human minor histocompatibility antigens. Curr Opin Immunol 1996;8:75–81. Goulmy E, Pool J, Van Loghem E, Völker-Dieben HJ: The role of human minor histocompatibility antigens in graft failure. A mini review. Eye 1995;9:180–184. Streilein JW: Anterior chamber associated immune deviation: The privilege of immunity in the eye.

Those genes constitute the major histocompatibility complex (MHC) of the species. Frelinger and Shreffler [4] have listed the following common features of MHCs: (1) principal transplantation barrier of the species; (2) serologically detected antigens of lymphocytes, broadly distributed on other tissues; (3) major factors which stimulate mixed leukocyte reaction (MLR) and graft-versus-host reaction (GVHR); (4) immune response genes; resistance to disease; (5) multiple phenotypic traits or functions controlled by a tight cluster of multiple genetic loci, and (6) extensive genetic polymorphism at many loci in the complex.

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