Advances in corneal graft rejection.
Advances in corneal graft rejection.
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DOI：
10.1097/icu.0000000000000767
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发表时间：
2021-07-01
影响因子：
3.7
通讯作者：
Yin, Jia
中科院分区：
文献类型：
--
作者：
Yin, Jia
关键词：
角膜移植后的免疫排斥反应是移植失败的主要危险因素。我们的目的是总结最近在理解和处理移植排斥反应的进展。免疫排斥仍然是穿透性角膜移植术中移植物失败的主要原因。虽然供体和受体之间的ABO血型和性别匹配可以减少排斥反应，但在一项随机研究中，人类白细胞抗原II类匹配并没有降低高风险穿透性角膜移植术的排斥反应风险。根据长期（5年及以上）研究，与穿透性角膜移植相比，深度前板层角膜移植、角膜剥离自动内皮角膜移植和角膜剥离膜内皮角膜移植的免疫排斥率分别较低，分别为1.7-13%、5 - 11.4%和1.7-2.8%。免疫排斥是否是这些板层角膜移植术中移植物失败的主要危险因素尚不清楚。虽然移植物排斥反应的系统性管理尚未取得重大进展，但局部非类固醇药物如他克莫司和抗血管内皮生长因子（VEGF）在高危病例中显示出希望。免疫排斥仍然是穿透性角膜移植术中移植物失败的主要原因。与穿透性角膜移植术相比，板层角膜移植术的排斥率明显降低。排斥反应在板层移植失败中的意义值得进一步研究。
Immune rejection after corneal transplantation is a major risk for graft failure. We aim to summarize recent advances in the understanding and management of graft rejection. Immune rejection remains the leading cause of graft failure in penetrating keratoplasty. While ABO blood type and sex match between donor and recipient may reduce rejection, human leucocyte antigens class II matching in a randomized study did not reduce the risk of rejection in high-risk penetrating keratoplasty. Compared with penetrating keratoplasty, deep anterior lamellar keratoplasty, descemet stripping automated endothelial keratoplasty, and descemet membrane endothelial keratoplasty have lower immune rejection rates of 1.7–13%, 5–11.4%, and 1.7–2.8%, respectively, based on long-term (5 years and more) studies. Whether immune rejection is a major risk factor for graft failure in these lamellar keratoplasties is unclear. While there have not been major advances in the systemic management of graft rejection, topical nonsteroid agents such as tacrolimus and anti-vascular endothelial growth factor (VEGF) have shown promise in high-risk cases. Immune rejection remains the leading cause of graft failure in penetrating keratoplasty. Lamellar keratoplasties have significantly lower rejection rates compared with penetrating keratoplasty. The significance of rejection in the failure of lamellar grafts warrants further investigation.
影响因子：
1.9
作者：
Eghtedari M;Kamalzadeh M;Yasemi M;Movahedan H;Ashraf MJ
通讯作者：
Ashraf MJ