PMID- 36371055
OWN - NLM
STAT- MEDLINE
DCOM- 20230117
LR  - 20230216
IS  - 1937-5913 (Electronic)
IS  - 1542-0124 (Linking)
VI  - 27
DP  - 2023 Jan
TI  - Outcomes of keratolimbal allograft from ABO compatible donors for severe 
      bilateral limbal stem cell deficiency.
PG  - 48-53
LID - S1542-0124(22)00094-5 [pii]
LID - 10.1016/j.jtos.2022.11.002 [doi]
AB  - PURPOSE: To report outcomes of keratolimbal allograft (KLAL) compatible for both 
      human leukocyte (HLA) and/or blood type using oral prednisone, mycophenolate, and 
      tacrolimus, with basiliximab if panel reactive antibodies (PRA) are present. 
      Intravenous immunoglobulin (IVIG) was used post-operatively if donor-specific 
      anti-HLA antibodies (DSA) were present. METHODS: Retrospective interventional 
      series of consecutive patients with KLAL for limbal stem cell deficiency (LSCD) 
      from HLA and/or blood type compatible deceased donors with a minimum follow-up 
      time of 12 months. Main outcome measures were ocular surface stability, visual 
      acuity and systemic immunosuppression (SI) adverse events. RESULTS: Eight eyes of 
      eight patients with mean age of 48.6 +/- 10.1 years (range 34-65 years) were 
      included. Mean follow-up time was 37.3 +/- 22.7 months (range 12-71 months) 
      following KLAL; four (50%) had combined LR-CLAL surgery. The etiologies of LSCD 
      were Stevens-Johnson Syndrome (n = 4/8), aniridia (n = 2/8), chemical injury 
      (n = 1/8) and atopic eye disease (n = 1/8). All patients had PRA present and 
      received basiliximab infusions. 5/8 patients received IVIG based on DSA 
      identified pre-operatively. At last follow-up, 7 eyes (87.5%) had a stable ocular 
      surface; 1 eye (12.5%) developed failure and had keratoprosthesis implantation. 
      There was a significant improvement in visual acuity from 1.65 +/- 0.48 to 
      0.68 +/- 0.34 logMAR (p = 0.01). SI was tolerated well with minimal adverse events. 
      CONCLUSIONS: Preliminary outcomes of KLAL with ABO compatible tissue using the 
      Cincinnati protocol, preoperative basiliximab (when PRA present) and 
      post-operative IVIG (when DSA present) are encouraging. This protocol may allow 
      for utilization of deceased donor tissue with results approximating those of 
      living donor tissue transplanted for severe bilateral LSCD.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Mimouni, Michael
AU  - Mimouni M
AD  - University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, 
      Ontario, Canada; Department of Ophthalmology, Rambam Health Care Campus 
      affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel 
      Institute of Technology, Haifa, Israel.
FAU - Cole, Edward
AU  - Cole E
AD  - Department of Medicine, Toronto General Hospital, University Health Network, 
      Toronto, Ontario, Canada.
FAU - Kim, S Joseph
AU  - Kim SJ
AD  - Department of Medicine, Toronto General Hospital, University Health Network, 
      Toronto, Ontario, Canada.
FAU - Schiff, Jeffrey
AU  - Schiff J
AD  - Department of Medicine, Toronto General Hospital, University Health Network, 
      Toronto, Ontario, Canada.
FAU - Cardella, Carl
AU  - Cardella C
AD  - Department of Medicine, Toronto General Hospital, University Health Network, 
      Toronto, Ontario, Canada.
FAU - Tinckam, Kathryn J
AU  - Tinckam KJ
AD  - Department of Medicine, Toronto General Hospital, University Health Network, 
      Toronto, Ontario, Canada.
FAU - Slomovic, Allan R
AU  - Slomovic AR
AD  - University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, 
      Ontario, Canada.
FAU - Chan, Clara C
AU  - Chan CC
AD  - University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, 
      Ontario, Canada. Electronic address: clarachanmd@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20221109
PL  - United States
TA  - Ocul Surf
JT  - The ocular surface
JID - 101156063
RN  - 9927MT646M (Basiliximab)
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Humans
MH  - Adult
MH  - Middle Aged
MH  - Aged
MH  - Cornea
MH  - *Corneal Diseases/surgery
MH  - Stem Cell Transplantation/methods
MH  - Basiliximab
MH  - Retrospective Studies
MH  - Immunoglobulins, Intravenous
MH  - Limbal Stem Cells
MH  - *Limbus Corneae
MH  - Prostheses and Implants
MH  - Allografts
OTO - NOTNLM
OT  - ABO blood type
OT  - Cadaver
OT  - Compatible
OT  - Deceased donor
OT  - HLA
OT  - KLAL
OT  - Keratolimbal allograft
OT  - Limbal stem cell deficiency
OT  - Limbal stem cell transplant
OT  - Matching
OT  - Ocular surface stem cell transplant
COIS- Declaration of competing interest None.
EDAT- 2022/11/13 06:00
MHDA- 2023/01/18 06:00
CRDT- 2022/11/12 19:38
PHST- 2022/07/27 00:00 [received]
PHST- 2022/11/05 00:00 [revised]
PHST- 2022/11/08 00:00 [accepted]
PHST- 2022/11/13 06:00 [pubmed]
PHST- 2023/01/18 06:00 [medline]
PHST- 2022/11/12 19:38 [entrez]
AID - S1542-0124(22)00094-5 [pii]
AID - 10.1016/j.jtos.2022.11.002 [doi]
PST - ppublish
SO  - Ocul Surf. 2023 Jan;27:48-53. doi: 10.1016/j.jtos.2022.11.002. Epub 2022 Nov 9.