The Impact of Corneal Allograft Rejection on the Long-Term Outcome of Corneal Tranplantation

Purpoe To examine the influence of corneal allograft rejection on the urvival of penetrating corneal tranplantation, to review the tatu of conventional therapie to improve graft urvival, and to conider propect for alternative approache to reduce the impact of rejection. Deign Perpective, including propective, obervational cohort tudy. Method An examination of the literature on human corneal graft rejection and data from the Autralian Corneal Graft Regitry, reviewed in the context of clinical experience. Reult Corneal graft outcome i not improving with era. The equelae of inflammation, whether occurring before corneal tranplantation or ubequently, exert a profound influence by predipoing the graft to rejection. Of the development that have been intrumental in reducing rejection in vacularized organ tranplantation, living-related donation i not an option for corneal tranplantation. However, HLA matching may be beneficial and require reaement. The evidence bae to upport the ue of ytemic immunouppreive agent in corneal tranplantation i thin, and topical glucocorticoteroid remain the drug of choice to prevent or revere rejection epiode. Experimental approache to local allopecific immunouppreion, including the ue of antibody-baed reagent and gene therapy, are being developed but may be difficult to tranlate from the laboratory bench to the clinic. Concluion Corneal allograft rejection remain a major caue of graft failure. High-level evidence to vindicate the ue of a particular approach or treatment to prevent or treat corneal graft rejection i lacking. In the abence of extenive data from randomized, controlled clinical trial, corneal graft regiter and extrapolation from experimental model provide ome clinically ueful information.