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Gewebetypisierung bei der perforierenden Keratoplastik

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Zusammenfassung

In den letzten Jahren ist aufgrund einer veränderten Beurteilung des Stellenwerts der HLA-Typisierung bei der perforierenden Keratoplastik die Nachfrage nach gematchten Spenderhornhäuten stark angestiegen. Neben den HLA- oder Major-Antigenen gibt es weitere immunologisch bedeutsame Gewebeoberflächenmoleküle, zu denen vor allem die Blutgruppen- und die Minor-Antigene zählen. Im Hinblick auf eine effektive Kosten-Nutzen- bzw. Wartezeit-Nutzen-Kalkulation sind differenzierte Matching-Strategien erforderlich, um eine optimale Nutzung und Verteilung der immer noch in ungenügender Zahl vorhandenen Korneatransplantate zu gewährleisten. Mit speziellen Matching-Strategien wie der Berechnung der individuellen Wartezeit, der Berücksichtigung von Split-, Non-MHC- und HLA-Antigenen, zusätzlichen HLA-Loci sowie „permissible“- und „taboo“-Mismatches wird in Zukunft mehr als nur die zahlenmäßige Übereinstimmung von HLA-Antigenen bei der Gewebetypisierung zu berücksichtigen sein. Dies wird es ermöglichen, von einer rein numerischen zu einer funktionellen Match-Strategie überzugehen. In dieser Übersicht wird der Stand der Diskussion zusammengefasst, und es werden verschiedene Strategien, Möglichkeiten und Grenzen sowohl der HLA- als auch der sonstigen Gewebetypisierung bei der perforierenden Keratoplastik erläutert.

Abstract

The demand for matched corneal grafts has risen rapidly over the last years. One reason for this is the change in the judgement of the value of tissue and especially HLA typing for prevention of an immune reaction in perforating corneal transplantation. Besides HLA or major antigens, there are other immunologically relevant tissue surface molecules such as the non-MHC antigens of which blood groups and minor antigens are the most important. With regard to effective cost-benefit and waiting time-benefit analyses, differentiated matching strategies are needed to assure optimized utilization and allocation of the still unsatisfactory number of available corneal grafts. With special matching strategies, such as the calculation of the individual waiting time, the consideration of split, non-MHC and HLA antigens, additional HLA loci as well as so-called “permissible” and “taboo” mismatches, much more has to be taken into account in the future than just the numerical correspondence of HLA antigens. This will make it possible to turn from a pure numerical approach to a functional matching strategy. This review summarizes the discussion and different matching strategies, possibilities and limitations of HLA and tissue typing in perforating corneal transplantation.

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  1. Augenklinik, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin

    J. Wachtlin, R. Khaireddin & F. Hoffmann

  2. Augenklinik, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 , Berlin

    J. Wachtlin

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  1. J. Wachtlin
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Wachtlin, J., Khaireddin, R. & Hoffmann, F. Gewebetypisierung bei der perforierenden Keratoplastik. Ophthalmologe 100, 1021–1030 (2003). https://doi.org/10.1007/s00347-003-0934-8

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