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Abstract #58938 Published in IGR 16-3
Corneal graft rejection 10 years after penetrating keratoplasty in the cornea donor study
Dunn SP; Gal RL; Kollman C; Raghinaru D; Dontchev M; Blanton CL; Holland EJ; Lass JH; Kenyon KR; Mannis MJ; Mian SI; Rapuano CJ; Stark WJ; Beck RW;Cornea 2014; 33: 1003-1009
PURPOSE: The aim of this study was to assess the effect of donor and recipient factors on corneal allograft rejection and evaluate whether a rejection event was associated with graft failure. METHODS: One thousand ninety subjects undergoing penetrating keratoplasty for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 12 years. Associations of baseline recipient and donor factors with the occurrence of a rejection event were assessed in univariate and multivariate proportional hazards models. RESULTS: Among 651 eyes with a surviving graft at 5 years, the 10-year graft failure (±99% confidence interval) rates were 12% ± 4% among eyes with no rejection events in the first 5 years, 17% ± 12% in eyes with at least 1 probable, but no definite rejection event, and 22% ± 20% in eyes with at least 1 definite rejection event. The only baseline factor significantly associated with a higher risk of definite graft rejection was a preoperative history of glaucoma, particularly when previous glaucoma surgery had been performed and glaucoma medications were being used at the time of transplant (10-year incidence 35% ± 23% compared with 14% ± 4% in eyes with no history of glaucoma/intraocular pressure treatment, P = 0.008). CONCLUSIONS: Patients who experienced a definite rejection event frequently developed graft failure raising important questions as to how we might change acute and long-term corneal graft management. Multivariate analysis indicated that previous use of glaucoma medications and glaucoma filtering surgery was a significant risk factor related to a definite rejection event.
*Michigan Cornea Consultants and Department of Ophthalmology, Oakland University/William Beaumont School of Medicine, Southfield-Rochester, MI; †Jaeb Center for Health Research, Tampa, FL; ‡Inland Eye Institute, Colton, CA; §Cincinnati Eye Institute and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH; ¶Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH; ‖Eye Health Vision Center, Tufts University School of Medicine, Harvard Medical School, Boston, MA; **University of California Davis, Sacramento, CA; ††WK Kellogg Eye Center, the University of Michigan, Ann Arbor, MI; ‡‡Corneal Associates, PC, Wills Eye Hospital, Philadelphia, PA; and §§The Johns Hopkins University School of Medicine, Baltimore, MD.
Full articleClassification:
9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
2.2 Cornea (Part of: 2 Anatomical structures in glaucoma)