Sensitization to human lymphocyte antigens by corneal transplantation

Although corneal transplantation is performed on patients with densely vascularized corneas, the likelihood of immunologic rejection is greater than in the nonvascularized cornea. In other organ transplantation systems, immune rejection has been correlated with the degree of antigenic disparity of the major histocompatibility antigens (HL-A) between the donor and the recipient. In this study, the authors applied the lymphocytotoxic test to demonstrate the development of host sensitization to the HL-A antigens by corneal graft rejection. Postoperative lymphocytotoxic antibodies developed in five of six patients whose graft failed from the allograft rejection, and in only one of eight patients following successful treatment of graft rejection. No detectable lymphocytotoxic antibodies developed in 15 patients who showed no evidence of immune graft rejection. The appearance of lymphocytotoxic antibodies at the time of corneal graft rejection leads to the conclusion that sensitization of corneal transplant recipients to the HL-A antigens of the donor can occur. Additionally, these findings appear to parallel the results in kidney transplantation, i.e., that the presence of anti HL-A lymphocytotoxins prior to transplantation predisposes to immune graft rejection.