Primary graft failure - A clinicopathologic and molecular analysis
Primary graft failure - A clinicopathologic and molecular analysis
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DOI：
10.1016/s0161-6420(00)00361-4
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发表时间：
2000-11-01
期刊：
影响因子：
13.7
通讯作者：
McLean, IW
中科院分区：
文献类型：
--
作者：
Cockerham, GC;Bijwaard, K;McLean, IW
目的：对原发性移植失败（PGF）角膜组织进行单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）分析。设计：回顾性、非比较性病例系列。材料：福尔马林固定、石蜡包埋的 21 例 PGF 供体角膜和 14 例受体角膜以及 10 例对照角膜。方法：研究临床、组织学、免疫组织化学、聚合酶链反应 (PCR)，以及选定病例的透射电子显微镜特征。主要结果指标：供体组织中存在 HSV 或 VZV 的证据。结果：患者中位年龄为65 岁，捐赠者年龄中位数为 48 岁。供体角膜参数，包括内皮细胞计数、死亡保存时间和储存时间，通常在公认的标准范围内。所有21个带有PGF的供体角膜均发现基质水肿，18个供体角膜表现出内皮严重减少或缺失，以及轻度至中度淋巴细胞浸润，无坏死。三个供体角膜（14%）患有坏死性基质角膜炎（NSK）并伴有角化沉淀。两名 NSK 供体角膜中的 2 名出现 HSV 角膜细胞免疫组织化学染色阳性，而其他 18 名供体角膜呈阴性，聚合酶链式反应分析显示，所有 NSK 供体角膜和 4 名无 NSK 供体角膜中均存在 1 型 HSV (HSV1) DNA (33%)，三名 NSK 患者的受者角膜组织中 HSV1 DNA 呈阴性，其他四名 PCR 阳性患者中的两名患者角膜组织中 HSV1 DNA 呈阳性患者。透射电子显微镜分析显示两个 NSK 供体角膜中存在病毒颗粒，聚合酶链式反应分析显示任何角膜中均未发现 2 型 HSV 或 VZV 的证据。所有对照角膜病毒DNA均为阴性，16个角膜在PGF再移植后保持透明，2个角膜失败，中位随访时间为3.6年。结论：33%的PGF患者存在单纯疱疹病毒1型DNA，部分失败角膜发现疱疹性基质性角膜炎；配对受体中缺乏 HSV 表明在供体角膜内输入。 PGF 后再移植的总体预后良好。眼科 2000；107:2083-2091 (C) 2000 年，美国眼科学会。
Objective: Primary graft failure (PGF) corneal tissues were analyzed for herpes simplex virus (HSV) and varicella-zoster virus (VZV).Design: Retrospective, noncomparative case series. Materials: Formalin-fixed, paraffin-embedded tissue of 21 donor corneas and 14 recipient corneas of PGF cases, as well as 10 control corneas.Methods: Clinical, histologic, immunohistochemical, polymerase chain reaction (PCR), and, in selected cases, transmission electron microscopic characteristics were studied.Main Outcome Measures: Evidence of HSV or VZV in donor tissues.Results: Median patient age was 65 years, and median donor age was 48 years. Donor cornea parameters, including endothelial cell counts, death-to-preservation time, and time in storage, were generally within accepted standards. Stromal edema was found in all 21 donor corneas with PGF, Eighteen donor corneas demonstrated severely reduced or absent endothelium and mild to moderate lymphocytic infiltration without necrosis. Three donor corneas (14%) had necrotizing stromal keratitis (NSK) with keratic precipitates. Positive immunohistochemical staining of keratocytes for HSV was present in two of two donor corneas with NSK and was negative in 18 other donor corneas, Polymerase chain reaction analysis revealed the DNA of HSV type 1 (HSV1) in all donor corneas with NSK and in four donor corneas without NSK (33%), Recipient corneal tissue was negative for HSV1 DNA in three patients with NSK and positive in two of the four other PCR-positive patients. Transmission electron microscopy analysis showed viral particles in two donor corneas with NSK, Polymerase chain reaction analysis revealed no evidence of HSV type 2 or VZV in any cornea. All control corneas were negative for viral DNA, Sixteen corneas remained clear and two had failed after regraft for PGF, with a median follow-up of 3.6 years.Conclusions: Herpes simplex virus type 1 DNA was present in 33% of patients of PGF, Herpetic stromal keratitis was found in some failed corneas; the lack of HSV in the paired recipient suggests importation within the donor cornea. The overall prognosis for regrafting after PGF is good. Ophthalmology 2000;107:2083-2091 (C) 2000 by the American Academy of Ophthalmology.