Effect of Donor and Recipient Factors on Corneal Graft Rejection

• Type of Material: Article
• Authors: R Doyle Stulting Jr., Emory University; Alan Sugar, The University of Michigan; Roy Beck, Jaeb Center for Health Research; Michael Belin, University of Arizona Department of Ophthalmology & Vision Science; Mariya Dontchev, Jaeb Center for Health Research; Robert S. Feder, Northwestern University; Robin L. Gal, Jaeb Center for Health Research; Edward J. Holland, Cincinnati Eye Institute; Craig Kollman, Jaeb Center for Health Research; Mark J. Mannis, University of California Davis; Francis Price, Price Vision Group; Walter Stark, The Johns Hopkins University School of Medicine; David D. Verdier, Verdier Eye Center, P.C.
• Language: English
• Date: 2012-10
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/ICO.0b013e31823f77f5
• Title of Journal or Parent Work: Cornea
• ISSN: 0277-3740
• Volume: 31
• Issue: 10
• Start Page: 1141
• End Page: 1147
• Grant/Funding Information: Additional support provided by: Eye Bank Association of America, Bausch & Lomb, Inc., Tissue Banks International, Vision Share, Inc., San Diego Eye Bank, The Cornea Society, Katena Products, Inc., ViroMed Laboratories, Inc., Midwest Eye-Banks (Michigan Eye-Bank, Illinois Eye-Bank), Konan Medical Corp., Eye Bank for Sight Restoration, SightLife, Sight Society of Northeastern New York (Lions Eye Bank of Albany), Lions Eye Bank of Oregon; Supported by cooperative agreements with the National Eye Institute, National Institutes of Health, Department of Health and Human Services EY12728 and EY12358.
• Keywords: Corneal Allograft Rejection; Corneal Transplantation; Graft Failure
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

Purpose To assess the relationship between donor and recipient factors and corneal allograft rejection in eyes that underwent penetrating keratoplasty (PK) in the Cornea Donor Study. Methods 1090 subjects undergoing corneal transplantation for a moderate risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema) were followed for up to 5 years. Associations of baseline recipient and donor factors with the occurrence of a probable or definite rejection event were assessed in univariate and multivariate proportional hazards models. Results Eyes with pseudophakic or aphakic corneal edema (N=369) were more likely to experience a rejection event than eyes with Fuchs’ dystrophy (N=676) (34% ± 6% versus 22% ± 4%; hazard ratio = 1.56; 95% confidence interval 1.21 to 2.03). Among eyes with Fuchs’dystrophy, a higher probability of a rejection event was observed in phakic post-transplant eyes compared with eyes that underwent cataract extraction with or without intraocular lens implantation during PK (29% vs. 19%; hazard ratio = 0.54; 95% confidence interval 0.36 to 0.82). Female recipients had a higher probability of a rejection event than males (29% vs. 21%; hazard ratio=1.42; 95% confidence interval 1.08 to 1.87), after controlling for the effect of preoperative diagnosis and lens status. Donor age and donor recipient ABO compatibility were not associated with rejection. Conclusions There was a substantially higher graft rejection rate in eyes with pseudophakic or aphakic corneal edema compared with eyes with Fuchs’ dystrophy. Female recipients were more likely to have a rejection event than males. Graft rejection was not associated with donor age.