Abstract
Corneal transplantation is not invariably successful despite the anterior chamber of the eye being an immunologically privileged site. Inflammation erodes privilege. Other than by reducing inflammation through meticulous surgery, careful postoperative surveillance, and effective topical corticosteroids in the postoperative phase, there is little that a surgeon can do to improve the outlook for the majority of patients receiving corneal transplants. For patients at appreciable risk, HLA Class I matching may help where it is available. So too will systemic immunosuppression where it can be justified. Despite these measures, the results of corneal transplantation have not shown the improvement seen in solid organ transplantation over the last 30 years. New approaches applicable to corneal transplantation are required.
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Williams KA, Muehlberg SM, Lewis RF, Giles LC, Coster DJ . Report from the Australian Corneal Graft Registry 1996. Mercury Press: Adelaide, 1997, pp 1–131.
Williams KA, Muehlberg SM, Bartlett CM, Esterman A, Coster DJ . Report from the Australian Corneal Graft Registry 1999. Snap Printing: Adelaide, 2000, pp 1–137.
Dernouchamps JP, Heremans JF . Molecular sieve effect of the blood–aqueous barrier. Exp Eye Res 1975; 21: 289–297.
Maurice D, Mishima S . Ocular pharmacokinetics. In: Sears M (ed). Pharmacology of the Eye. Springer-Verlag: Berlin, 1984, pp 19–116.
Kuchle M, Nguyen NX, Naumann GO . Aqueous flare following penetrating keratoplasty and in corneal graft rejection. Arch Ophthalmol 1994; 112: 354–358.
Barker CF, Billingham RE . Immunologically privileged sites and tissues. In: Porter R, Knight J (eds). Corneal Graft Failure Ciba. Foundation Symposium 15 (new series). Elsevier: Amsterdam; Excerpta Medica: North-Holland, 1973, pp 79–104.
Medawar P . Immunity of homologous grafted skin III. The fate of skin homografts transplanted to the brain, to subcutaneous tissue, and to the anterior chamber of the eye. Br J Exp Pathol 1948; 29: 58–69.
Whitsett CF, Stulting RD . The distribution of HLA antigens on human corneal tissue. Invest Ophthalmol Vis Sci 1984; 25: 519–524.
Nelken E, Michaelson IC, Nelken D, Gurebitch J . ABO antigens in the human cornea. Nature 1956; 177: 840.
Salisbury JD, Gebhardt BM . Blood group antigens on human corneal cells demonstrated by immunoperoxidase staining. Am J Ophthalmol 1981; 91: 46–50.
Jager MJ . Corneal Langerhans cells and ocular immunology. Reg Immunol 1992; 4: 186–195.
Baudouin C, Brignole F, Pisella PJ, Becquet F, Philip PJ . Immunophenotyping of human dendriform cells from the conjunctival epithelium. Curr Eye Res 1997; 16: 475–481.
Williams KA, Ash JK, Coster DJ . Histocompatibility antigen and passenger cell content of normal and diseased human cornea. Transplantation 1985; 39: 265–269.
Catry L, Van den Oord J, Foets B, Missotten L . Morphologic and immunophenotypic heterogeneity of corneal dendritic cells. Graefes Arch Clin Ex Ophthalmol 1991; 229: 182–185.
Wilson SE, Li Q, Weng J, Barry-Lane PA, Jester JV, Liang Q et al. The Fas-Fas ligand system and other modulators of apoptosis in the cornea. Invest Ophthalmol Vis Sci 1996; 37: 1582–1592.
Griffith TS, Yu X, Herndon JM, Green DR, Ferguson TA . CD95-induced apoptosis of lymphocytes in an immune privileged site induces immunological tolerance. Immunity 1996; 5: 7–16.
Stuart PM, Griffith TS, Usui N, Pepose J, Yu X, Ferguson TA . CD95 ligand (FasL)-induced apoptosis is necessary for corneal allograft survival. J Clin Invest 1997; 99: 396–402.
Wilbanks GA, Mammolenti M, Streilein JW . Studies on the induction of anterior chamber-associated immune deviation (ACAID). III. Induction of ACAID depends upon intraocular transforming growth factor-beta. Eur J Immunol 1992; 22: 165–173.
D'Orazio T, Niederkorn JY . A novel role for TGF-beta and IL-10 in the induction of immune privilege. J Immunol 1998; 160: 2089–2098.
Taylor AW, Streilein JW, Cousins SW . Alpha-melanocyte-stimulating hormone suppresses antigen-stimulated T cell production of gamma-interferon. Neuroimmunomodulation 1994; 1: 188–194.
Taylor AW, Streilein JW, Cousins SW . Immunoreactive vasoactive intestinal peptide contributes to the immunosuppressive activity of normal aqueous humor. J Immunol 1994; 153: 1080–1086.
Streilein JW . Peripheral tolerance induction: lessons from immune privileged sites and tissues. Transplant Proc 1996; 28: 2066–2070.
Williams KA, Coster DJ . Rethinking immunological privilege: implications for corneal and limbal stem cell transplantation. Mol Med Today 1997; 3: 495–515.
Kuchle M, Nguyen NX, Naumann GO . Aqueous flare following penetrating keratoplasty and in corneal graft rejection. Arch Ophthalmol 1994; 112: 354–358.
Collin HB . Endothelial cell lined lymphatics in the vascularized rabbit cornea. Invest Ophthalmol 1996; 5: 337–354.
Coster DJ . Factors affecting the outcome of corneal transplantation. Ann R Coll Surg Engl 1981; 63: 91–97.
Treselet PA, Foulks GN, Sanfilippo F . The expression of HLA antigens by cells in the human cornea. Am J Ophthalmol 1984; 98: 763–772.
Pepose JS, Gardner KM, Nestor MS, Foos RY, Pettit Th . Detection of HLA class I and II antigens in rejected human corneal allografts. Ophthalmology 1985; 92: 1480–1484.
Williams KA, White MA, Ash JK, Coster DJ . Leukocytes in the graft bed associated with corneal graft failure. Analysis by immunohistology and actuarial graft survival. Ophthalmology 1989; 96: 38–44.
Katami M, Madden PW, White DJ, Watson PG, Kamada N . The extent of immunological privilege of orthotopic corneal grafts in the inbred rat. Transplantation 1989; 41: 371–376.
Egan RM, Yorkey C, Black R, Loh WK, Stevens JL, Woodward JG . Peptide-specific T cell clonal expansion in vivo following immunization in the eye, an immune-privileged site. J Immunol 1996; 157: 2262–2271.
Yamagami S, Dana MR . The critical role of lymph nodes in corneal alloimmunization and graft rejection. Invest Ophthalmol Vis Sci 2001; 42: 1293–1298.
Tuft SJ, Coster DJ . The corneal endothelium. Eye 1990; 4: 389–424.
The Collaborative Corneal Transplantation Studies Research Group. The collaborative corneal transplantation studies (CCTS). Effectiveness of histocompatibility matchin in high-risk corneal transplantation. Arch Ophthalmol 1992; 110: 1392–1403.
Gore SM, Vail A, Bradley VA, Rogers CA, Easty DL, Armitage WJ . HLA-DR matching in corneal transplantation. Systemic review of published evidence Corneal. Transplant Follow-up Study Collaborators. Transplantation 1995; 60: 1033–1039.
Batchelor JR, Casey TA, Werb A, Gibbs DC, Prasad SS, Lloyd DF et al. HLA matching and corneal grafting. Lancet 1976; 1: 551–554.
Volker-Dieben HJ, Kok-van Alphen CC, Lansbergen Q, Persijn GG . The effect of prospective HLA-A and -B matching and corneal graft survival. Acta Ophthalmol (Copenhagen) 1982; 60: 203–212.
Foulks GN, Sanfilippo FP, Locascio III JA, MacQueen JM, Dawson DV . Histocompatibility testing for keratoplasty in high-risk patients. Ophthalmology 1983; 90: 230–244.
Sanfilippo F, MacQueen JM, Vaughn WK, Foulks GN . Reduced graft rejection with good HLA-A and B matching in high-risk corneal transplantation. N Engl J Med 1986; 315: 29–35.
Hoffman F, von Keyserlingk HJ, Wiederholt M . Importance of HLA DR matching for corneal transplantation in high-risk cases. Cornea 1986; 5: 139–143.
Baggesen K, Lamm LU, Ehlers N . Significant effect of high-resolution HLA-DRB1 matching in high-risk corneal transplantation. Transplantation 1996; 62: 1273–1277.
Munkhbat B, Hagihara M, Sato T, Tsuchida F, Sato K, Shimazaki J et al. Association between HLA-DPB1 matching and 1-year rejection-free graft survival in high-risk corneal transplantation. Transplantation 1997; 63: 1011–1016.
Vail A, Gore SM, Bradley BA, Easty DL, Rogers CA, Armitage WJ . Influence of donor and histocompatibility factors on corneal graft outcome. Transplantation 1994; 58: 1210–1216.
Hill JC . Systemic cyclosporin in high-risk keratoplasty: short versus long term therapy. Ophthalmology 1994; 101: 128–133.
Hill JC . Systemic cyclosporin in high-risk keratoplasty: long term results. Eye 1995; 9: 422–428.
Denton MD, Magee CC, Sayegh MH . Immunosuppressive strategies in transplantation. Lancet 1999; 353: 1083–1091.
Hill JC, Maske R, Watson P . Corticosteroids in corneal graft rejection: oral versus single pulse therapy. Ophthalmology 1991; 98: 329–333.
Ippoliti G, Fronterre A . Use of locally injected anti-T monoclonal antibodies in the treatment of acute corneal graft rejection. Transplant Proc 1987; 19: 2579–2580.
Ippoliti G, Fronterre A . Usefulness of CD3 or CD6 anti-T monoclonal antibodies in the treatment of acute corneal graft rejection. Transplant Proc 1989; 21: 3133–3134.
Newman DK, Isaacs JD, Watson PG, Meyer PA, Hale G, Waldmann H . Prevention of immune-mediated corneal graft destruction with the anti-lymphocyte monoclonal antibody, CAMPATH-1H. Eye 1995; 9: 564–569.
Dick AD, Meyer P, James T, Forrester JV, Hale G, Waldmann H et al. Campath-1H therapy in refractory ocular inflammatory disease. Br J Ophthalmol 2000; 84: 107–109.
Schmitz K, Hitzer S, Behrens-Baumann W . Immune suppression by combination therapy with basiliximab and cyclosporin in high risk keratoplasty. A pilot study. Ophthalmologe 2002; 99: 38–45.
Thiel MA, Coster DJ, Standfield SD et al. Penetration of engineered antibody fragments into the eye. Clin Exp Immunol 2002; 128: 67–74.
Klebe S, Sykes P, Coster D, Krishnan R, Williams K . Prolongation of sheep corneal allograft survival by transfer of the gene encoding ovine interleukin 10 to donor corneal endothelium. Transplantation 2001; 15: 1214–1220.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coster, D., Williams, K. Management of high-risk corneal grafts. Eye 17, 996–1002 (2003). https://doi.org/10.1038/sj.eye.6700634
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6700634
Keywords
This article is cited by
-
Boston keratoprosthesis type 1: outcomes of the first 38 cases performed at Moorfields Eye Hospital
Eye (2018)
-
Biomaterials-enabled cornea regeneration in patients at high risk for rejection of donor tissue transplantation
npj Regenerative Medicine (2018)
-
Trends in corneal transplant surgery in Ireland: indications and outcomes of corneal transplant surgery and intraocular lens opacification following Descemet’s stripping automated endothelial keratoplasty
Irish Journal of Medical Science (1971 -) (2018)
-
Prospects for genetic modulation of corneal graft survival
Eye (2009)
