Predisposing factors in corneal graft rejection

Area of Science:

• Ophthalmology
• Immunology
• Transplantation Science

Background:

• Perforating keratoplasty is a common surgical procedure for corneal blindness.
• Immunoreactions remain a significant cause of graft failure after keratoplasty.
• Identifying risk factors is crucial for improving graft survival rates.

Purpose of the Study:

• To evaluate the incidence of immunoreactions following perforating keratoplasty.
• To identify specific risk factors associated with post-keratoplasty immunoreactions.
• To assess the correlation between preoperative risk stratification and immunoreaction occurrence.

Main Methods:

• A retrospective analysis of 357 patients undergoing perforating keratoplasty over 12 years.
• Patients were categorized into low-risk and high-risk groups based on defined criteria.
• Statistical analysis was performed to determine the relative risk of immunoreactions associated with various factors.

Main Results:

• An overall incidence of 20% for immunoreactions was observed.
• Significant risk factors for immunoreactions in high-risk patients included preoperative diagnosis, transplant diameter (≥7.5 mm), limited HLA-B/DR compatibility (<2 antigens), and postoperative anterior chamber inflammation (blood/fibrin).
• A linear relationship was found between the likelihood of being in a less-favorable-prognosis group and the occurrence of immunoreactions.

Conclusions:

• Preoperative risk stratification and careful consideration of specific factors can help predict immunoreactions after keratoplasty.
• Managing high-risk factors such as inflammation and ensuring better HLA compatibility may reduce graft rejection.
• Further research into optimizing surgical techniques and immunosuppression protocols is warranted to improve long-term graft survival.