Long-term outcome of RPE allografts in non-immunosuppressed patients with AMD
Abstract
Purpose: To determine the long-term outcome of human retinal pigment epithelium (RPE) transplants in patients with advanced age-related macular degeneration (AMD). Methods: Using pars plana microsurgical techniques, RPE allografts were transplanted subretinally to four groups of AMD patients: five patients received organized patch transplants after removal of choroidal neovascular membranes, four got small patch transplants in dry AMD; suspensions of RPE cells were transplanted in five cases with dry AMD, and two patients with RPE tears. None received immunosuppression. Transplants were followed for 24–38 months by biomicroscopy, fundus photography, SLO microperimetry, and fluorescein angiography. Rejection was defined as loss of visual function over the transplant, development of an exudative response (subretinal fluid with or without neovascularization), fluorescein leakage, and disruption, depigmentation, or encapsulation of the transplant. Results: Four of 16 transplants (25%) presented no clinical signs of rejection. Three of the four small patch transplants remained pigmented and essentially unchanged after 30–32 months. Clinical signs of graft rejection appeared within three months in all cases of neovascular AMD (disrupted blood-retinal barrier, BRB), but after 6 - 20 months in five of nine eyes with non-exudative AMD (intact BRB). Conclusions: Subretinal human RPE allografts present a high rejection rate (75%) without immunosuppression. However, small extrafoveal transplants remained unchanged in shape, size and color for more than two years in non-exudative AMD. A disrupted BRB is likely to enhance graft rejection, which occurs earlier in exudative than in non-exudative AMD.
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Clinical trials using allogenic RPE cells for the treatment of AMD two decades ago were all met with graft rejection.
“clinical trials conducted using allogenic RPE cells for the treatment of AMD, 2 decades ago, were all met with graft rejection (38–42).”
From Subretinal therapy: technological solutions to surgical and immunological challenges (2022) · cites this paper as [40]
Previous allogeneic RPE cell transplantations in dry AMD resulted in graft rejections in some cases, although rejection started later and was seen less frequently than in patients with wet AMD.
“Previous allogeneic RPE cell transplantations in dry AMD resulted in graft rejections in some cases, although it started later in the treatment course and was seen less frequently than in patients with wet AMD (Algvere et al., 1997, Algvere et al., 1999).”
From Treatment of macular degeneration using embryonic stem cell-derived retinal pigment epithelium: Preliminary results in Asian patients (2015) · cites this paper as Algvere et al., 1999
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- Authors
- Algvere, P. V., Gouras, P., & Dafgård Kopp, E.
- Affiliations
- Linköping University (SE)
- Columbia University (US)
- Department of Ophthalmology, Karolinska Institute, St. Erik's Eye Hospital, Stockholm - Sweden
- ORCID
- Gouras, P.
- Venue
- European Journal of Ophthalmology
- Publisher
- SAGE Publications
- Published
- 1999-07
- Volume
- 9
- Issue
- 3
- Pages
- 217-230
- ISSN
- 1120-6721 (ISSN-L)
- 1724-6016
- OpenAlex
- W1480779622
- Cited by
- 219
- References
- 31
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 3 · 2021: 8 · 2020: 9 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 6 · 2015: 13 · 2014: 4 · 2013: 4 · 2012: 11
- FWCI
- 8.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinal Development and Disorders
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Keywords
- age-related macular degeneration, graft rejection, non-immunocompromised patient, subretinal transplantation, choroidal neovascularization, dry age-related macular degeneration, long-term outcomes
- MeSH terms
- Age Factors, Aged, Female, Fluorescein Angiography, Graft Rejection, Humans, Immunosuppression Therapy, Macular Degeneration, Male, Middle Aged, Pigment Epithelium of Eye, Pregnancy, Ophthalmologic Surgical Procedures, Time Factors, Transplantation, Homologous, Vitrectomy, Treatment Outcome
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