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Murine Corneal Transplantation: A Model to Study the Most Common Form of Solid Organ Transplantation
Published on: November 17, 2014
Corneal transplant survival after onset of severe endothelial rejection
Michael D Wagoner1, Rola Ba-Abbad, John E Sutphin
1Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. mwagoner@kkesh.med.sa
Insights
Severe endothelial rejection after penetrating keratoplasty (PK) significantly impacts corneal graft survival. This complication carries a high risk of graft failure, underscoring the need for effective management strategies.
Area of Science:
- Ophthalmology
- Transplantation immunology
Background:
- Penetrating keratoplasty (PK) is a common procedure for corneal blindness.
- Endothelial rejection is a significant cause of corneal graft failure post-PK.
Purpose of the Study:
- To evaluate corneal graft survival rates following severe endothelial rejection after penetrating keratoplasty (PK).
Main Methods:
- Retrospective case series analysis of 157 corneal grafts (152 patients) from King Khaled Eye Specialist Hospital (1998-2002).
- Inclusion criteria required PK performed between 1983-2002 with at least 3 months follow-up.
- Kaplan-Meier analysis was used to determine graft survival.
Main Results:
- Rejection episodes were reversed in 57.3% of grafts within 3 months.
- Graft survival rates were 42.6% at 1 year and 36.1% at 3 years post-PK.
- Surgical indication, donor/patient age, and prior rejection history were significant factors influencing graft survival.
Conclusions:
- Severe endothelial rejection is a major complication of PK, leading to a substantial risk of graft failure.
- Early reversal of rejection improves outcomes, but long-term survival remains a concern.
- Identifying risk factors is crucial for improving patient management and graft longevity.
Purpose:
To evaluate corneal graft survival after onset of severe endothelial rejection after penetrating keratoplasty (PK).
Design:
Retrospective case series.
Participants:
One hundred fifty-six patients (161 PKs) treated at a single center.
Methods:
Retrospective review of the medical records of every case of severe endothelial rejection admitted to the King Khaled Eye Specialist Hospital (KKESH) between January 1, 1998 and December 31, 2002. Patients for whom PK had been performed at KKESH between June 1, 1983 and December 31, 2002 and in whom at least 3 months of follow-up was available were included in the statistical analysis.
Main Outcome Measure:
Graft survival.
Results:
One hundred fifty-seven PKs (152 patients) met the inclusion criteria and were included in the statistical analysis. Four PKs (4 patients) were excluded from the statistical analysis due to inadequate follow-up. The rejection episode was reversed during the first 3 months in 90 grafts (57.3%). By Kaplan-Meier analysis, graft survivals were 42.6% at 1 year and 36.1% at 3 years. The surgical indication for PK significantly correlated with likelihood of reversibility (P<0.001) and long-term graft survival (P<0.001). Risk factors associated with an increased risk of postrejection graft failure included increasing donor age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.04-1.24; P = 0.004), increasing patient age (OR, 1.23; 95% CI, 1.11-1.35; P<0.001), and history of rejection episodes (P = 0.002).
Conclusion:
Endothelial rejection is a serious complication of PK, with a high risk of graft failure.
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