Immunological considerations and concerns as pertinent to whole eye transplantation

Zor, Fatih^a,∗; Karagoz, Huseyin^a,∗; Kapucu, Hulya^a; Kulahci, Yalcin^a; Janjic, Jelena M.^b,c; Gorantla, Vijay S.^a

^aDepartments of Surgery, Ophthalmology and Bioengineering, Wake Forest University Health Sciences, Wake Forest Institute for Regenerative Medicine, Winston Salem, North Carolina

^bGraduate School of Pharmaceutical Sciences, School of Pharmacy

^cChronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA

Correspondence to Vijay S. Gorantla, MD, PhD, FRCS, Departments of Surgery, Ophthalmology and Bioengineering, Wake Forest University of Health Sciences, Wake Forest Institute for Regenerative Medicine, Winston Salem, NC 27101, USA. E-mail:[email protected]

Current Opinion in Organ Transplantation24(6):p 726-732, December 2019. |DOI:10.1097/MOT.0000000000000713

Abstract

Purpose of review

The advent of clinical vascularized composite allotransplantation (VCA), offers hope for whole eye transplantation (WET) in patients with devastating vison loss that fails or defies current treatment options. Optic nerve regeneration and reintegration remain the overarching hurdles to WET. However, the realization of WET may indeed be limited by our lack of understanding of the singular immunological features of the eye as pertinent to graft survival and functional vision restoration in the setting of transplantation.

Recent findings

Like other VCA, such as the hand or face, the eye includes multiple tissues with distinct embryonic lineage and differential antigenicity. The ultimate goal of vision restoration through WET requires optimal immune modulation of the graft for successful optic nerve regeneration. Our team is exploring barriers to our understanding of the immunology of the eye in the context of WET including the role of immune privilege and lymphatic drainage on rejection, as well as the effects ischemia, reperfusion injury and rejection on optic nerve regeneration.

Summary

Elucidation of the unique immunological responses in the eye and adnexa after WET will provide foundational clues that will help inform therapies that prevent immune rejection without hindering optic nerve regeneration or reintegration.