Introdução: O transplante de órgãos, um dos maiores avanços da medicina, se tornou popular, sendo mais comum para córneas, envolvendo a substituição, completo (penetrante) ou parcial (lamelar ou profundo) da córnea doente. A esperada eficácia do transplante é quase sempre alcançada, devendo aos cuidados tanto com doador quanto receptor, relevando da rejeição do tecido até os cuidados após intervenção. Objetivo: Compreender a importância da imunologia para os transplantes de tecidos oftalmológicos. Materiais e Métodos: Pesquisa bibliográfica digital, no google academic, combinando os termos transplantes, imunogenética e córnea. Resultados: A rejeição do transplante é processo imunológico de descompensação da córnea transplantada. A principal razão para o bom efeito está no privilégio da córnea, devido ao viés imunológico que ocorre no segmento anterior, abreviado ACAID (Anterior Chamber Associated Immune Deviation), que perde sua eficiência num processo inflamatório, aumentando o número de células de Langerhans e a expressão de antígenos classe I e II do complexo principal de histocompatibilidade, aumentando citocinas pró-inflamatórias oculares, provocando neovascularização da córnea. A perda do privilégio imunológico é acompanhada de rejeição, e seu mecanismo pode ser dividido em três etapas: (a) Rejeição do braço aferente - reconhecer o sistema imunológico de antígenos heterólogos como principal componente da rejeição do braço aferente. As células de Langerhans são um fator chave nesse processo, pois além de estimular os linfócitos B e T, processam e apresentam antígenos ao sistema imunológico; (b) Estágio central da rejeição - reconhecer um antígeno como heterólogo ativa os linfócitos T imaturos para proliferar e realizar a expansão clonal; (c) Braço eferente da rejeição - reação eferente da rejeição do transplante de córnea, mediada por células e nenhum anticorpo envolvido. As principais células que comandam a destruição do enxerto são os linfócitos T CD4+, que recrutam outras células efetoras: macrófagos, leucócitos polimorfonucleares e linfócitos NK (natural killer), que liberam citocinas, como o fator de necrose tumoral, destruindo células do doador. Conclusão: O endotélio com capacidade de replicação limitada é a razão do insucesso do transplante do doador. A compreensão dos aspectos imunológicos da rejeição, as manifestações clínicas e a classificação da rejeição são fundamentais aos oftalmologistas na personalização do tratamento.
Publicado
2021-11-08
Como Citar
Santos, A. L. dos . (2021). COMPREENDENDO A IMUNOLOGIA NOS TRANSPLANTES DE TECIDOS OFTALMOLÓGICOS. Revista Multidisciplinar Em Saúde, 2(4), 19. https://doi.org/10.51161/rems/2333
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