The Veneto Eye Bank Foundation, Zelarino, Venezia, Italy.
Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Cell Tissue Bank. 2021 Mar;22(1):47-56. doi: 10.1007/s10561-020-09864-x. Epub 2020 Sep 15.
To evaluate the effect of donor-to-recipient sex mismatched (male donor corneas to female recipients) on the incidence of rejection episodes and failures up to 1 year after corneal transplantation. Prospective observational cohort study, with donor corneas randomly assigned and surgeons blind to the sex of donor. A unique eye bank retrieved and selected the donor corneas transplanted in 4 ophthalmic units in patients with clinical indication for primary or repeated keratoplasty for optical reasons, perforating or lamellar, either anterior or posterior. Rejection episode defined as any reversible or irreversible endothelial, epithelial or stromal sign, with or without development of corneal edema, and graft failure as a permanently cloudy graft or a regraft for any reason detected or acknowledged during a postoperative ophthalmic visit at any time up to 1 year after surgery were recorded.156 (28.6%) patients resulted donor-to-recipient gender mismatched for H-Y antigen (male donor to female recipient). During the 12 months follow-up, 83 (14.7%, 95% CI 12.0-17.9) grafts showed at least 1 rejection episode and 17 (3.2%, 95% CI 2.0-5.0) failed after immune rejection, among 54 (9.6%, 95% CI 7.4-12.3) grafts failed for all causes. No significant differences between matched and mismatched patients were found for cumulative incidence of both rejection episodes (15.2% and 13.5%) and graft failures following rejection (3.2% and 2.6%), respectively. Multivariable analyses showed that H-Y matching either is not a predictive factor for rejection or graft failure nor seems to influence incidence of failures on respect to patient's risk category. The lack of influence of donor-to-recipient mismatched on the rate of rejections and graft failures resulting from this study do not support the adoption of donor-recipient matching in the allocation of corneas for transplantation.
评估供体-受者性别不匹配（男性供体角膜用于女性受者）对角膜移植后 1 年内排斥反应发作和失败的影响。这是一项前瞻性观察队列研究，供体角膜随机分配，外科医生对供体的性别不知情。一个独特的眼库检索并选择了 4 个眼科单位的供体角膜进行移植，这些供体角膜用于因光学原因、穿透性或板层性、前或后角膜进行原发性或重复穿透性角膜移植的患者，有临床适应证。排斥反应发作定义为任何可逆或不可逆的内皮、上皮或基质迹象，伴有或不伴有角膜水肿的发展，移植物失功定义为永久性混浊移植物或因任何原因导致的再次移植，这些原因在术后眼科随访期间任何时间点被检测到或承认，随访时间长达 1 年。156 名（28.6%）患者因 H-Y 抗原（男性供体用于女性受者）而出现供体-受者性别不匹配。在 12 个月的随访期间，83 名（14.7%，95%CI 12.0-17.9）移植术后发生至少 1 次排斥反应发作，17 名（3.2%，95%CI 2.0-5.0）发生免疫排斥后失功，54 名（9.6%，95%CI 7.4-12.3）因所有原因而失功。在累积排斥反应发作（分别为 15.2%和 13.5%）和排斥后移植物失功（分别为 3.2%和 2.6%）的患者中，匹配和不匹配患者之间没有发现显著差异。多变量分析显示，H-Y 匹配既不是排斥反应或移植物失功的预测因素，也似乎不会影响患者风险类别相关的失功发生率。本研究中供体-受者不匹配对排斥反应和移植物失功发生率的影响缺乏支持，因此不支持在角膜分配中采用供体-受者匹配。
