Abstract
Purpose: to evaluate the effectiveness of plasmapheresis as a method for preventing and treating the graft rejection reaction in corneal transplantation.Patients and methods. The study involved patients with surgical pathology of the cornea, who underwent a prophylactic course of plasmapheresis procedures and underwent penetrating keratoplasty (Main group); and patients with surgical pathology of the cornea who underwent penetrating keratoplasty, but did not undergo plasmapheresis (Comparison group), whose data were analyzed retrospectively. The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group.Results. Patients with keratoplasty who received a course of therapeutic plasmapheresis in the perioperative period demonstrated a statistically significant increase in the number of cases of a decrease in the level of C-reactive protein and a statistically significant decrease in the median values of the mean stimulated cytochemical index and the mobilization coefficient. Depending on the risk group for keratoplasty, the patients showed different dynamics of the levels of the studied interleukins after the course of plasmapheresis and keratoplasty. In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24 %) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn’t demonstrate any cases of graft disease. In patients of the Comparison group (in total for two subgroups), the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. At the same time, the patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease (in both subgroups).Conclusion: the obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.
Highlights
Цель данного исследования — проанализировать иммунологическую и клиническую эффективность плазмафереза в качестве способа предотвращения и те‐ рапии реакции отторжения трансплантата при сквозной кератопластике
who underwent a prophylactic course of plasmapheresis procedures
The control group consisted of conditionally healthy individuals of both genders
Summary
В составе основной группы были две равные подгруппы: основная 1 (n = 21) — пациенты с не‐ осложненным кератоконусом и, соответственно, с кера‐ топластикой низкого риска (КНР); основная 2 (n = 21) — пациенты с диагнозом: эрозия, язва, фистула роговицы, и, соответственно, с кератопластикой высокого риска (КВР). Критерии включения: для обеих подгрупп основной группы и группы сравнения — наличие хирургической патологии роговицы (кератоконус (КНР); дистрофия, эрозия, язва, фистула роговицы, буллезная кератопатия, болезнь трансплантата, бельмо роговицы (КВР)); воз‐ раст 18–60 лет. У 14 пациентов основной груп‐ пы дополнительно были выполнены иммунологические исследования таких параметров, как стимулирован‐ ный цитохимический индекс (СЦИст) и коэффициент мобилизации (КМ), определявшихся при проведении NBT-теста с нейтрофильными гранулоцитами. Несостоятельность или БТ определялась в случае упоминания в базе данных или медицинской карте пациента о развитии БТ в каче‐ стве основного, сопутствующего диагноза или послеопе‐ рационного осложнения; при проведении рекератопла‐ стики или назначении курса консервативной терапии БТ. Различия между сравниваемыми величинами считались статистически значимыми при p < 0,05
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