The impact of corneal allograft rejection on the long-term outcome of corneal transplantation
The impact of corneal allograft rejection on the long-term outcome of corneal transplantation
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DOI：
10.1016/j.ajo.2005.07.024
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发表时间：
2005-12-01
影响因子：
4.2
通讯作者：
Williams, KA
中科院分区：
文献类型：
--
作者：
Coster, DJ;Williams, KA
目的：研究同种异体角膜移植排斥反应对穿透性角膜移植存活率的影响，回顾提高移植角膜存活率的传统治疗方法的现状，并探讨减少排斥反应影响的替代方法的前景。设计：视角，包括前瞻性、观察性队列研究。方法：查阅有关人类角膜移植排斥反应的文献和澳大利亚角膜移植登记处的数据，并结合临床经验进行综述。炎症的后遗症，无论是发生在角膜移植前还是之后，都会通过使植片发生排斥反应而产生深远的影响。在有助于减少血管器官移植排斥反应的发展中，活体供体不是角膜移植的一种选择。然而，人类白细胞抗原配型可能是有益的，需要重新评估。支持在角膜移植中使用全身免疫抑制剂的证据很少，局部应用糖皮质激素仍然是预防或逆转排斥反应的首选药物。局部同种异体免疫抑制的实验方法正在开发中，包括使用抗体、抗体、基于试剂的试剂和基因治疗，但从实验室到临床可能很难转化。结论：角膜移植排斥反应仍然是移植失败的主要原因。缺乏高水平的证据来证明使用特定的方法或治疗来预防或治疗角膜移植排斥反应。在缺乏来自随机对照临床试验的大量数据的情况下，角膜移植登记和从实验模型推断提供了一些临床有用的信息。
PURPOSE: To examine the influence of corneal allograft rejection on the survival of penetrating corneal transplantation, to review the status of conventional therapies to improve graft survival, and to consider prospects for alternative approaches to reduce the impact of rejection.DESIGN: Perspective, including prospective, observational cohort study.METHODS: An examination of the literature on human corneal graft rejection and data from the Australian Corneal Graft Registry, reviewed in the context of clinical experience.RESULTS: Corneal graft outcome is not improving with era. The sequelae of inflammation, whether occurring before corneal transplantation or subsequently, exert a profound influence by predisposing the graft to rejection. Of the developments that have been instrumental in reducing rejection in vascularized organ transplantation, living-related donation is not an option for corneal transplantation. However, HLA matching may be beneficial and requires reassessment. The evidence base to support the use of systemic immunosuppressive agents in corneal transplantation is thin, and topical glucocorticosteroids remain the drugs of choice to prevent or reverse rejection episodes. Experimental approaches to local allospecific immunosuppression, including the use of anti, body,based reagents and gene therapy, are being developed but may be difficult to translate from the laboratory bench to the clinic.CONCLUSIONS: Corneal allograft rejection remains a major cause of graft failure. High-level evidence to vindicate the use of a particular approach or treatment to prevent or treat corneal graft rejection is lacking. In the absence of extensive data from randomized, controlled clinical trials, corneal graft registers and extrapolation from experimental models provide some clinically useful information.