PMID- 14966417
OWN - NLM
STAT- MEDLINE
DCOM- 20040329
LR  - 20191210
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 77
IP  - 3
DP  - 2004 Feb 15
TI  - Beneficial effect of matching at the HLA-A and -B amino-acid triplet level on 
      rejection-free clear graft survival in penetrating keratoplasty.
PG  - 417-21
AB  - 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 homogeneous 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<0.05), whereas conventional HLA-A and HLA-B 
      matching did not result in any statistically significant reduction of immune 
      reactions because of lack of statistical power (P=0.08). Triplet-string matching 
      (13 mismatches accepted) reduces median time on the waiting list by 80%. 
      CONCLUSIONS: Triplet-string matching seems to improve mid- to long-term prognosis 
      in penetrating keratoplasties while simultaneously reducing time on the waiting 
      list in most cases. It should thus be considered for histocompatibility 
      determination in penetrating keratoplasty.
FAU - Bohringer, Daniel
AU  - Bohringer D
AD  - Eye Hospital and LIONS Cornea Bank Baden-Wurttemberg, University Hospital, 
      Albert-Ludwigs-Universitat Freiburg, Freiburg, Germany. 
      boehringer@aug.ukl.uni-freiburg.de
FAU - Reinhard, Thomas
AU  - Reinhard T
FAU - Duquesnoy, Rene J
AU  - Duquesnoy RJ
FAU - Bohringer, Stefan
AU  - Bohringer S
FAU - Enczmann, Jurgen
AU  - Enczmann J
FAU - Lange, Peter
AU  - Lange P
FAU - Claas, Frans
AU  - Claas F
FAU - Sundmacher, Rainer
AU  - Sundmacher R
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
SB  - IM
MH  - Aged
MH  - Female
MH  - Graft Rejection/etiology
MH  - *Graft Survival
MH  - HLA-A Antigens/*genetics
MH  - HLA-B Antigens/*genetics
MH  - Histocompatibility Testing/*standards
MH  - Humans
MH  - *Keratoplasty, Penetrating
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - *Repetitive Sequences, Amino Acid
MH  - Risk
MH  - Time Factors
MH  - Waiting Lists
EDAT- 2004/02/18 05:00
MHDA- 2004/03/30 05:00
CRDT- 2004/02/18 05:00
PHST- 2004/02/18 05:00 [pubmed]
PHST- 2004/03/30 05:00 [medline]
PHST- 2004/02/18 05:00 [entrez]
AID - 10.1097/01.TP.0000110415.10401.94 [doi]
PST - ppublish
SO  - Transplantation. 2004 Feb 15;77(3):417-21. doi: 
      10.1097/01.TP.0000110415.10401.94.