Importance of HLA DR Matching for Corneal Transplantation in High-Risk Cases

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Abstract
Twenty patients with a poor prognosis were treated with keratoplasty. The corneas were obtained from multiorgan donors. The histocompatibility antigens of donors and recipients were determined. All patients received topical postoperative treatment with cyclosporin A 2% (total dose 450–500 mg) and dexamethasone 0.1% eyedrops at a low dosage (total dose 7–11 mg). During a follow-up period of 23 months (4–32 months), 12 patients (60%) developed immunoreactions, which were reversible in six cases and led to corneal clouding in six others. There was found to be a significant dependence on the frequency of compatible HLA B (p < 0.05) and DR antigens (p < 0.01), but not on that of the A antigens. All immunoreactions occurred in the 13 patients in whom none or only one of the HLA A, B, and DR antigens was compatible. According to the results of this study, it appears advisable to perform keratoplasty in high-risk cases only if at least one DR antigen and one other HLA A or B antigen are compatible.

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