Beneficial effect of matching at the HLA-A and -B amino-acid triplet level on rejection-free clear graft survival in penetrating keratoplasy
Beneficial effect of matching at the HLA-A and -B amino-acid triplet level on rejection-free clear graft survival in penetrating keratoplasy
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DOI：
10.1097/01.tp.0000110415.10401.94
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发表时间：
2004-02-15
期刊：
影响因子：
6.2
通讯作者：
Sundmacher, R
中科院分区：
文献类型：
--
作者：
Böhringer, D;Reinhard, T;Sundmacher, R
客观的。人类白细胞抗原（HLA）匹配对穿透性角膜移植术长期预后的有益影响现已明确，但必须根据个人情况权衡额外的等待时间。 HLAMatchmaker 是一种用于组织相容性测定的分子算法，可以识别免疫学上可接受的错配，从而可能显着减少等待名单上的时间，而不会对预后产生负面影响。方法。 HLAMatchmaker 算法（三联串匹配）应用于 545 例正常风险角膜移植术中的每例，在分层分辨率下已知完整的 HLA 类型。定义了两个同质组。第 I 组由 147 例穿透性角膜移植术组成，具有多达 13 个三联体串不匹配（单个 HLA-A 或 HLA-B 等位基因不匹配情况下的典型外来上限），并使用 Kaplan-Meier 方法和对数秩统计与其余 398 名具有更多三联体不匹配的患者（第 II 组）进行比较。还对基于常规 HLA-A 和 HLA-B 匹配的明确移植物存活率进行了分析。与传统的 HLA-A 和 HLA-B 匹配相比，单独预测等待名单上的时间会减少。结果。穿透性角膜移植术后 3 年，三线匹配使 I 组的无排斥反应透明移植物存活率为 85%，但 II 组仅为 76%（P
Objective. The beneficial effect of human leukocyte antigen (HLA) matching on long-term prognosis in penetrating keratoplasty is now unequivocal but has to be weighed against the additional waiting period on an individual basis. HLAMatchmaker is a molecularly based algorithm for histocompatibility determination that can identify immunologically acceptable mismatches and thus potentially reduce time on the waiting list dramatically without negatively affecting prognosis.Methods. The HLAMatchmaker algorithm (triplet-string matching) was applied on each of 545 normal-risk keratoplasties for which complete HLA type was known at split-level resolution. Two homogenous groups were defined. Group I consisted of the 147 penetrating keratoplasties with up to 13 triplet-string mismatches (the typical upper limit of foreign in case of a single HLA-A or HLA-B allele mismatch) and was compared to the remaining 398 patients with more triplet mismatches (group II) using the Kaplan-Meier method and log-rank statistics. Analysis of clear graft survival on the basis of conventional HLA-A and HLA-B matching was performed as well. Reduction of time on the waiting list as compared to conventional HLA-A and HLA-B matching was predicted individually.Results. Triplet-string matching yielded 85% rejection-free clear graft survival 3 years after penetrating keratoplasty in group I but only 76% in group II (P