NR 6/2003
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Przeszczepy r±bkowych komórek macierzystych
od zgodnych pod względem HLA dawców rodzinnych. Obserwacja długoterminowa
Limbal stem cell transplantations from HLA-compatible
living-related donors. Long-term observation
Edward Wylęgała, Dorota Tarnawska, Ewa Marta Wróblewska
Z Oddziału Okulistyki Okręgowego Szpitala Kolejowego w Katowicach
Kierownik: dr n. med. Edward Wylęgała |
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| Summary: |
Purpose: The assessment of clinical outcome
in patients after lr-CLAL procedure.
Materials and methods: Retrospective, interventional case series
including 11 patients (12 eyes), all with non-ambulatory visual acuity (from light
perception to hand movements). Mean age was 39,4 years (ranging from 18 to 76 years). In 7
eyes Limbal Stem Cells Deficiency (LSCD) resulted from chemical burn, in 2 eyes from
ocular cicatricial pemphigoid, in one eye from Stevens-Johnson syndrome (SJS). In one eye
congenital LSCD was diagnosed and in another one post-inflammatory LSCD. Mean follow-up
was 16,2 months (from 10 to 32). Among donors prospective class I HLA matching was
performed. Maximal two mismatches were accepted. General immunosuppressive therapy was
switched-on in all subjects.
Surgical excision of corneal pannus with clearing of limbal area was performed. Five clock
hours stem cells tissue grafts from living related donors were harvested and transplanted
to the recipient eye. Three penetrating keratoplasty, one deep lamellar keratoplasty and
seven amniotic membrane transplantations were additionally performed. Main outcome
measures were graft survival as a restoration of corneal epithelium, visual acuity
improvement and complication in donors and recipients. Kaplan- Meyer survival curve and
generalized Peto test were used for comparison.
Results: The graft survival was 83,6% in mean 20,3 months follow-up (from
10 to 32 months). Two cases of graft failure concern eye with SJS and eye with PKP
regrafting after chemical burn.
Visual improvement in 7 cases (58,3%), the same visual acuity in 4 cases (33,3%) and
deterioration one case (8,3%) were noted. Ambulatory vision in 50% of patients was
achieved. Graft rejection syndrome in four eyes was noticed also when ideal matching and
CsA serum level 220 ng/ml. Two cases were treated with success and another two grafts
failed. No complications in donors eyes were noticed. Impression cytology in eyes with
successful grafts not related to pathological changes.
Conclusions: Lr-CLAL are effective in ocular surface restoration.
Living-related donors are suitable source of stem cells for cultivation in vitro. The
prognosis for stem cells grafting is definitely worse when eyelid anomaly and adhesions
exist. |
| Słowa kluczowe: |
przeszczep r±bkowych komórek macierzystych, dawca
rodzinny, typowanie HLA, rekonstrukcja powierzchni oka. |
| Key words: |
limbal stem cells transplantation, living related donor, HLA
matching, ocular surface reconstruction. |
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