Characteristics of immune rejection after allogeneic cultivated limbal epithelial transplantation.

Abstract

To investigate the characteristics and prognosis of immune rejection after allogeneic cultivated limbal epithelial transplantation (CLET). Retrospective, noncomparative case series. Forty-two eyes of 41 patients undergoing allogeneic CLET for total limbal stem cell deficiency who completed a follow-up of at least 12 months. Allogeneic cultivated limbal epithelial cells using human amniotic membrane as a carrier were transplanted into the recipient eye. Immune rejection occurred in 10 eyes; the medical records of these patients were reviewed. Best-corrected visual acuity, corneal opacification and neovascularization, immunofluorescence staining of CD4 and CD8 T cells, and distribution of Langerhans cells (LCs) in the corneal epithelium. The corneal epithelium became edematous with epithelial rejection lines and peripheral epithelial defects in 6 eyes. Circumlimbal vessels were hyperemic and extended up to the corneal stroma, thus resulting in aggravation of corneal neovascularization in 8 eyes. Corneal stromal opacification was observed in 9 eyes. CD4(+) or CD8(+) T cells were detected in 5 of 6 eyes from which impression cytology specimens were obtained. In vivo confocal microscopy examination revealed an accumulation of LCs in the central and peripheral corneal epithelium. All patients responded to antirejection therapy. One eye developed a second episode. The diagnosis of immune rejection after allogeneic CLET mainly depends on typical clinical manifestations. Delayed recognition can result in worsening corneal opacification and neovascularization. Reasonable use of topical immunosuppressives and a close follow-up within 6 months after allogeneic CLET are critical to improve the prognosis. The author(s) have no proprietary or commercial interest in any materials discussed in this article.