Long-term outcome in high-risk corneal transplantation and the influence of HLA-A and HLA-B matching
Long-term outcome in high-risk corneal transplantation and the influence of HLA-A and HLA-B matching
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DOI：
10.1097/00003226-200308000-00013
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发表时间：
2003-08-01
期刊：
影响因子：
2.8
通讯作者：
Beekhuis, WH
中科院分区：
文献类型：
--
作者：
Bartels, MC;Doxiadis, IIN;Beekhuis, WH
目的。目的：评价配型后高危角膜移植的长期随访，并确定配型是否能降低免疫性角膜移植失败的风险。方法：研究方法。共有303例高危角膜移植纳入研究。使用广泛的人类白细胞抗原-A和-B抗原数据，在每个位点接受0或1个错配，获得I类抗原匹配的供体角膜。在裂解分型水平上进行了人类白细胞抗原分析。对免疫性移植物衰竭的影响。用Kaplan-Meier统计量和Cox回归分析基于裂解分型的匹配数量增加的I类抗原。观察移植物存活情况和移植适应证。结果。排斥反应是34%的移植物失败的原因。根据分裂分型，人类白细胞抗原-A和-B配型为0或I的组的无免疫失败移植物存活率显著高于对照组(LOG-RANK检验，P=0.002)。多因素分析显示，裂解抗原配型的优势比为0.41。结论。在我们的高危人群中，三分之一的移植失败是由不可逆转的移植排斥反应引起的。基于HLA-A和-B位点0或I分裂抗原不匹配的供体角膜的分配有助于提高无免疫失败的移植物存活率，并可能导致更高的移植物存活率。
Purpose. To evaluate long-term follow-up of high-risk corneal transplants allocated after matching for broad HLA-A and HLA-B antigens and to establish whether matching for HLA-A and -B antigen "splits" would result in a reduced risk of immunologic graft failure. Methods. A total of 303 high risk corneal transplants was included. Class I antigen-matched donor corneas were obtained using broad HLA-A and -B antigen data and accepting 0 or 1 mismatch at each locus. Analysis of HLA antigens was performed also on the split typing level. The influence on immunologic graft failure. for an increasing number of matched class I antigens based on split typing was analyzed with Kaplan-Meier statistics and Cox regression. Graft survival and indication for transplantation were investigated. Results. Rejection was the cause of 34% of all graft failures. A significantly higher immune failure free graft survival was found in a group with 0 or I HLA-A and -B mismatch based on split typing (log-rank test, P = 0.002). A beneficial effect of matching for split antigens was shown with multivariate analysis (odds ratio, 0.41). Conclusions. One third of graft failures in our high-risk population was caused by irreversible graft rejection. Allocation of donor corneas based on a 0 or I split antigen mismatch at both HLA-A and -B loci could contribute to a higher immune failure free graft survival and could result in a higher overall graft survival.