Effect of Factors Unrelated to Tissue Matching on Corneal Transplant Endothelial Rejection

doi:10.1016/0002-9394(89)90262-6

American Journal of Ophthalmology

Volume 107, Issue 6, June 1989, Pages 647-654

https://doi.org/10.1016/0002-9394(89)90262-6 Get rights and content

We examined 348 consecutive adult recipients of a corneal transplant for clinical signs of an endothelial rejection episode in a single-center follow-up study. The variables studied included primary diagnosis, number of previous corneal transplants, previous transplant failures from rejection episodes, transplant size, recipient corneal vascularization, donor age, recipient age and sex, past blood transfusions, and number of pregnancies. Five important risk factors were identified: primary diagnosis of herpetic, interstitial, or traumatic keratitis; transplant size 8 mm and larger; more than one previous corneal transplant; recipients younger than 60 years of age; and the presence of recipient corneal vascularization. This information will serve eventually for analyzing the effect of donor recipient tissue matching on corneal transplant rejection.

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There are more references available in the full text version of this article.

Cited by (88)

Diagnosis and Management of Immune-mediated Disorders of the External Eye
2024, Advances in Ophthalmology and Optometry
Deep anterior lamellar keratoplasty: A surgeon's guide
2018, Journal of Current Ophthalmology
Citation Excerpt :
Selection of appropriate cases for DALK is vital for successful outcomes. In general, older patients are less likely to have frequent rejection episodes, as their immune systems are not as strong as young patients.39–41 The most common indication for DALK is keratoconus,42 and these patients tend to be younger.
To review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique.
In this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications.
A standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies.
Although there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.
Penetrating Keratoplasty for Keratoconus With and Without Resolved Corneal Hydrops: Long-term Results
2016, American Journal of Ophthalmology
To evaluate the long-term risk of endothelial rejection, graft survival, and associated factors following penetrating keratoplasty (PK) for keratoconus, with and without prior resolved corneal hydrops.
Retrospective cohort study.
Primary outcome measures were endothelial rejection–free survival and failure-free survival. Secondary outcome measures were corneal neovascularization following hydrops and complications following PK.
A total of 245 eyes underwent PK for keratoconus with mean follow-up of 5.6 ± 3.6 years. Eyes with prior hydrops (n = 74) had lower endothelial rejection–free survival rates compared with eyes without prior hydrops: 86.5% ± 4.0% vs 86.5% ± 2.6% at 1 year, 61.0% ± 6.2% vs 76.9% ± 3.3% at 5 years, and 45.8% ± 10.1% vs 70.9% ± 4.3% at 10 years, respectively (P = .023). Multivariate analysis identified factors associated with endothelial rejection as age ≤25 years (P = .017), corneal neovascularization (P = .001), donor trephination size >8 mm (P = .017), and poor clinic attendance (P = .015). There was no difference in the failure-free survival rates with and without prior hydrops: 98.6% ± 1.3% vs 97.1% ± 1.3% at 1 year, 97.3% ± 1.9% vs 95.1% ± 1.9% at 5 years, and 97.3% ± 1.9% vs 92.2% ± 2.7% at 10 years, respectively (P = .42). Corneal neovascularization was present at the time of PK in 44.6% of eyes with prior hydrops and 7.6% without prior hydrops (P < .001).
Corneal neovascularization, a frequent complication of corneal hydrops, was associated with increased risk of endothelial rejection following PK. However, allograft survival was similar in eyes with and without prior hydrops.
Indications and outcomes of corneal transplantation in geriatric patients
2013, American Journal of Ophthalmology
To identify the most common corneal transplant procedures, indications, coexisting ocular diseases, and outcomes in elderly patients, and to compare younger geriatric patients with super-geriatric patients.
Retrospective case series.
Data of all patients 65 years old and older who underwent corneal transplantation at Wills Eye Institute from April 2007 to January 2013, and were followed up for at least 1 year, were collected. Two hundred seventy-one eyes of 253 patients were divided into 2 groups according to the age of the patient.
Group I (65-79 years old) included 181 eyes and Group II (80 years and older) included 90 eyes. The most common indication was Fuchs endothelial dystrophy, with 78 eyes (43%) in Group I and 34 eyes (38%) in Group II. In Group I, 93 Descemet stripping endothelial keratoplasty (DSEK) (51%), 84 penetrating keratoplasty (PK) (46%), and 4 keratoprosthesis procedures(2%) were performed; in Group II, 37 DSEK (41%), 51 PK (57%), and 2 keratoprosthesis procedures (2%) were performed. Graft survival rate at last visit was 90% for Group I and 88% for Group II. Rejection occurred in 18 Group I eyes (10%) and 7 Group II eyes (8%) (P = .562).
Endothelial abnormalities were more common indications and keratoconus was a less common indication for surgery in the elderly. Fuchs dystrophy was the leading indication for surgery in both super-geriatric and younger geriatric patients. Graft survival rate was slightly higher in the younger geriatric age group but was not statistically significant. In the elderly, there is an increased prevalence of both glaucoma and retinal diseases that can affect the visual outcomes after corneal transplantation.
Long-term outcomes in patients who received a corneal graft for keratoconus between 1980 and 1986
2013, American Journal of Ophthalmology
To estimate the probability of allograft rejection, graft failure, and recurrent keratoconus (KC) and to assess vision-specific quality of life 20 to 25 years after corneal transplantation for KC.
Retrospective case series.
Two hundred nineteen eyes of 184 subjects were identified from the Michigan Corneal Transplantation Patient Registry as receiving corneal transplantation for KC from 1980 through 1986. Current ophthalmic examinations and the 25-item National Eye Institute Visual Function Questionnaire were obtained. Kaplan-Meier analyses were used to estimate the time-related probability of allograft rejection, graft failure, and KC recurrence. Cox regression was used to identify predictive factors of these outcomes. The 25-item National Eye Institute Visual Function Questionnaire scores were summarized with descriptive statistics.
Follow-up was available up to 27 years after surgery (median, 10 years). Rejection occurred in 98 of 219 grafts. Most rejections occurred in the first 2 years (probability, 41%; standard error, 3%). KC recurrence was noted in 6 grafts 9 to 20 years after surgery, with a 20-year probability of 10% (standard error, 4%). Eighteen grafts failed, with a 20-year probability of 12% (standard error, 3%). Larger host trephine size, male donor gender, and nonwhite donor race were associated with increased rejection hazard. Worse astigmatism and nonwhite recipient race were associated with increased failure hazard. Twenty-eight subjects completed the 25-item National Eye Institute Visual Function Questionnaire at an average of 23 years after surgery (range, 18 to 26 years). Their mean composite score was 84.5 (standard deviation, 12.1).
Allograft rejection is frequent in the 2 years after corneal graft for KC. However, the 20-year probabilities of graft failure and recurrent KC are low. Given the relative youth of KC graft recipients, these statistics should enhance the information they receive.
Descemet's stripping endothelial keratoplasty under failed penetrating keratoplasty: Visual rehabilitation and graft survival rate
2011, Ophthalmology
To evaluate graft survival, risk factors for failure, complications, and visual rehabilitation in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) under a failed penetrating keratoplasty (PK).
Retrospective interventional case series.
Sixty eyes (60 patients) treated at Price Vision Group, Indianapolis, Indiana.
Graft diameters ranged from 8 to 9 mm and were ∼1 mm larger than the previous PK. The Descemet's membrane was not stripped in the majority (54, 84%). The graft was inserted using forceps or a Busin funnel glide (Moria, Anthony, France). The probability of graft survival was calculated by Kaplan–Meier survival analysis.
Graft survival, best-corrected visual acuity (BCVA), and complications.
The mean recipient age was 68 years (range, 17–95 years). Forty eyes had 1 previous failed PK, 14 eyes had 2 previous failed PKs, and 6 eyes had 3 previous failed PKs. Thirty-one eyes (52%) had preexisting glaucoma, and 16 eyes (27%) had prior glaucoma surgery (trabeculectomy in 4, shunt procedure in 12). Fifty-five grafts were performed for visual rehabilitation, and 5 grafts were performed for pain relief. Median follow-up was 2.3 years (range, 2 months to 6 years). Median preoperative BCVA was 1.23 logarithm of the minimum angle of resolution (logMAR) (range, 0.2–3, Snellen 20/340), and median postoperative visual improvement was 0.6 logMAR (6 lines), range −0.3 to +2.7. Four eyes had graft detachment (6.6%), 7 eyes (10.5%) had endothelial rejection, and 10 eyes (16.6%) had graft failure (primary failure in 2, secondary failure in 8). The overall secondary graft survival rates were 98%, 90%, 81%, and 74% at 1, 2, 3, and 4 years, respectively. Prior glaucoma shunt was the principal risk factor for graft failure. The graft survival rates were 100%, 96%, 96%, and 96% in eyes without a prior shunt versus 93%, 74%, 44%, and 22% with a prior shunt at 1, 2, 3, and 4 years, respectively (P=0.0005; relative risk = 20). Peripheral anterior synechiae (P=0.14), neovascularization (P=0.88), endothelial rejection (P=0.59), and number of prior PKs (P=0.13) were not independent risk factors for graft failure.
Endothelial keratoplasty under a previous failed PK is a useful alternative to a repeat standard PK, particularly in eyes with an acceptable topography and refractive outcome before failure.
Proprietary or commercial disclosure may be found after the references.

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This study was supported by grants from Health and Welfare Canada and the Banque d'Yeux Nationale.

Reprint requests to Hélène M. Boisjoly, Room S-5, CHUL Research Center, 2705 Laurier, Ste-Foy, Qc, Canada G1V 4G2.

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Effect of Factors Unrelated to Tissue Matching on Corneal Transplant Endothelial Rejection

The allogaft rejection reaction. The leading cause of late failure of clinical corneal grafts

Hierarchy of prognostic factors for corneal allograft survival

Aust. N.Z. J. Ophthalmol.

An analysis of corneal transplantation. I. Graft clarity

Ann. Ophthalmol.

Corneal transplant allograft reaction. Possible predisposing factors

Trans. Am. Ophthalmol. Soc.

The fate of corneal regrafts after previous rejection reactions

HLA matching and corneal transplantation

N. Engl. J. Med.

HLA-A, B and DR matching in corneal transplantation

Ophthalmology

Reduced graft rejection with good HLA-A and B matching in high-risk corneal transplantation

N. Engl. J. Med.

HLA typing and primary cadaver graft survival

Transplant. Proc.