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Rejection and acceptance of corneal allografts

Klebe, Sonja; Coster, Douglas J; Williams, Keryn A

Current Opinion in Organ Transplantation: February 2009 - Volume 14 - Issue 1 - p 4–9
doi: 10.1097/MOT.0b013e32831af1d7
Mechanisms of rejection: Edited by Bruce Hall

Purpose of review Corneal transplantation is successful in the short-term, but the long-term prognosis has not improved over the past 20 years. Here, we review recent findings that may contribute to improved corneal allograft survival.

Recent findings A better understanding of the molecular pathways affecting corneal graft survival has led to more targeted approaches to immune modulation. Costimulatory molecule blockade, inhibition of chemokine–chemokine receptor interactions, modulation of apoptotic pathways, and reduction of corneal neovascularization and lymphangiogenesis have been shown to prolong corneal graft survival in animal models. Conventional immunosuppressive drugs have been tested in new combinations and formulations with some success. Two randomized prospective clinical trials in clinical penetrating corneal transplantation have been reported, but there remains little evidence on the long-term outcomes of the newer lamellar corneal graft procedures.

Summary New approaches to reducing the impact of rejection on corneal graft survival have focussed on topical rather than systemic therapies, and on component corneal transplantation. The most successful experimental strategies have been those in which more than one pathway has been targeted; it now seems likely that to improve clinical allograft survival, simultaneous modulation of multiple axes of the rejection process will be necessary.

Department of Ophthalmology, Flinders University, Adelaide, Australia

Correspondence to Keryn Williams, Department of Ophthalmology, Flinders Medical Centre, Bedford Park, SA 5042, Australia Tel: +61 8 8204 4899; fax: +61 8 8277 0899; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.