Corneal graft rejection 10 years after penetrating keratoplasty in the cornea donor study

Abstract

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.

Figures

Figure 1. Life Table Plot of Cumulative Probability of Any (Probable or Definite) and Definite Rejection Episodes and 10-Year 99% CI (N=1,090)

The table under the figure presents the number of subjects at risk in the beginning of each interval. CI = confidence interval.

Figure 2. Life Table Plot of Cumulative Probability of Definite Rejection Events by Diagnosis and Lens Status and 10-Year 99% CI (N=1,045*)

Kaplan-Meier cumulative probabilities of graft survival are shown for 4 diagnosis and lens status combinations. With a log-rank test, the p value comparing the four groups was 0.02. The table under the figure presents the number of subjects at risk in the beginning of each interval. CI = confidence interval.

Figure 3. Multivariate Analysis of Baseline Recipient and Donor Factors Predictive of Definite Rejection Eventa

CI = confidence interval.

Figure 4. Conditional on 5-Year Graft Survival, Cumulative Probabilities of Graft Failure According to the Strongest Sign of Graft Rejection over the First 5 Years of Follow-up (N=651)

Conditional on graft survival at 5.5 years (upper limit for the 5 year visit window), Kaplan-Meier cumulative probabilities of graft failure and 10-year 99% CI are shown for no rejection, possible/probable rejection, and definite rejection at 5 years. CI = confidence interval.