Keratolimbal allograft (KLAL) with human leukocyte antigen (HLA) and/or blood type-compatible deceased donor tissue for severe bilateral limbal stem cell deficiency (LSCD) yields encouraging safety and efficacy results, according to a report published in The Ocular Surface.
Researchers conducted a retrospective interventional series of consecutive patients to evaluate safety and efficacy outcomes of KLAL with HLA and/or ABO-compatible deceased donor tissue using oral prednisone, mycophenolate, and tacrolimus in patients with severe bilateral LSCD. If panel reactive antibodies were present, basiliximab was used preoperatively, and if donor-specific anti-HLA antibodies were present, intravenous immunoglobulin (IVIG) was used postoperatively.
The main outcome measures were ocular surface stability, visual acuity, and systemic immunosuppression adverse events. All patients had a minimum follow-up time of 12 months.
A total of 8 eyes of 8 patients (50% women and 50% men; mean age, 48.6±10.1 years [range, 34-65]) were included in the study. The mean follow-up time after KLAL was 37.3±22.7 months (range, 12-71). Half of the patients had combined living-related conjunctival-limbal allograft surgery (LR-CLAL).
The researchers report all patients had panel reactive antibodies and received basiliximab infusions preoperatively and 5 of 8 patients (63%) had donor-specific anti-HLA antibodies and received IVIG postoperatively. At last follow-up exam, 7 eyes (87.5%) had a stable ocular surface, and 1 eye (12.5%) had failure and keratoprosthesis implantation. They observed a significant improvement in visual acuity from 1.65±0.48 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.68±0.34 logMAR postoperatively (P =.01).
The team reported that systemic immunosuppression was well tolerated with minimal adverse events: mild diffuse rejection episodes (n=2); development of diabetes mellitus type 2 (n=1); fungal keratitis (n=4); and herpes simplex epithelial keratitis (n=2).
“The long-term ocular surface stability rates, rejection rates and visual acuity outcomes seem comparable to those previously reported for LR-CLAL alone. Therefore, testing for HLA and blood type compatibility of deceased donors along with tailored use of preoperative basiliximab and postoperative IVIG seems like a promising regimen for patients with advanced bilateral LSCD,” according to the report.
Limitations of the study included the retrospective design and small sample size.
Mimouni M, Cole E, Kim SJ, et al. Outcomes of keratolimbal allograft from ABO compatible donors for severe bilateral limbal stem cell deficiency. Ocul Surf. Published online November 9 2022. doi:10.1016/j.jtos.2022.11.002