Metabolic therapy of predicted complications in immunocompromised recipients before repeated corneal transplantation

Abstract

One of the topical problems of modern ophthalmotransplantology is the graft engraftment after repeated keratoplasty. During repeated corneal transplantation, the frequency of graft rejection increases significantly. The study included 121 patients aged 19 to 89 years with corneal graft failure, who were scheduled for repeated corneal transplantation. Immunophenotyping of major and small populations of peripheral blood lymphocytes was performed by flow cytometry (CytoFlex BC, USA). The intensity of energy metabolism in lymphocyte populations was determined by the activity of succinate dehydrogenase and NADH dehydrogenase by immunocytochemical method using flow cytometry. An increase in the content of B lymphocytes (p = 0.004) and a decrease in Th17 lymphocytes (p = 0.013) were revealed after the use of a course of metabolic therapy. Against the background of therapy, the activity of SDH in the T lymphocyte population significantly increases (p = 0.034). In addition, in the studied populations of lymphocytes in the recipient group, against the background of metabolic therapy, the normalization of SDH activity is observed: the number of recipients with low and high enzyme activity decreases. After a course of metabolic therapy, a significant decrease in NADHDH activity was revealed (p = 0.034). Indicators of lymphocyte populations and mitochondrial enzyme activity in recipients after a course of metabolic therapy indicated a more favorable prognosis for repeated corneal transplantation. Evaluation of the results of repeated keratoplasty a year after surgery showed that 59 recipients received transparent graft engraftment, and in 62 patients the graft became cloudy in the period from 1 to 8 months after surgery. In the group of patients with transparent graft engraftment, the percentage of recipients receiving metabolic therapy was significantly higher than in the group of recipients with graft opacity (41%±2.05% vs 21%±2.91%, p 0.001). Conducting metabolic therapy before surgery reduces the number of realized unfavorable prognoses of the result of rekeratoplasty, and monitoring the activity of dehydrogenases and the content of lymphocyte populations allows us to evaluate the effectiveness of therapeutic and preventive measures in immunocompromised recipients.