Long-term results of allogeneic penetrating limbo-keratoplasty in total limbal stem cell deficiency.
OBJECTIVE
To determine the prognosis of allogeneic penetrating limbo-keratoplasty in patients with total limbal stem cell deficiency and to find out if donor limbal stem cells survive in the long run.


METHODS
Noncomparative prospective case series.


METHODS
Forty-eight patients with total limbal stem cell deficiency.


METHODS
Allogeneic penetrating limbo-keratoplasty. All patients received systemic cyclosporin A and/or mycophenolate mofetil in the postoperative course. Thirteen patients received grafts with 0 to 1 HLA mismatches in the HLA-A, HLA-B, and HLA-DR loci; 13 patients received grafts with 2 to 6 mismatches; and 22 patients received untyped grafts.


METHODS
Long-term clear graft survival and survival of donor limbal stem cells.


RESULTS
Five years postoperatively, 65% of the grafts with 0 to 1 mismatches, 41% of the grafts with 2 to 6 mismatches, and 14% of the untyped grafts were clear centrally (estimation according to Kaplan-Meier log rank test, P = 0.03). Immunogenetic analysis of epithelial cells from the surface of the graft could be performed successfully in 7 of 9 patients and revealed donor DNA in the epithelium of 5 of these 7 patients up to 56 months postoperatively.


CONCLUSIONS
Long-term survival of donor epithelium could be demonstrated immunogenetically in patients undergoing allogeneic penetrating limbo-keratoplasty. Human leukocyte antigen-matched grafts seem to deliver better results than untyped grafts. Progress with matching and immunosuppressive strategies may further improve current results.
Reinhard
Thomas
T
Eye Hospital, Albert-Ludwigs University, Killianstrasse 5, 79106 Freiburg, Germany. Reinhard@aug.ukl.uni-freiburg.de
Spelsberg
Helga
H
Henke
Lotte
L
Kontopoulos
Theodoros
T
Enczmann
Jürgen
J
Wernet
Peter
P
Berschick
Peter
P
Sundmacher
Rainer
R
Böhringer
Daniel
D
D000328:Adult; D002470:Cell Survival; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007125:Immunogenetics; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015948:Keratoplasty, Penetrating / Q000379:methods*; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011379:Prognosis; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D013234:Stem Cells / Q000473:pathology*; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid