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Factors Associated With Graft Rejection in the Cornea Preservation Time Study.

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Graft rejection after Descemet stripping automated endothelial keratoplasty (DSAEK) is uncommon, particularly in older patients. Younger recipients face a higher risk, and rejection can increase endothelial cell loss, though it

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Area of Science:

  • Ophthalmology
  • Transplantation Surgery
  • Corneal Disease

Background:

  • Descemet stripping automated endothelial keratoplasty (DSAEK) is a common procedure for corneal endothelial dysfunction.
  • Understanding factors influencing graft rejection is crucial for improving long-term outcomes.
  • The Cornea Preservation Time Study (CPTS) provided a robust dataset to investigate DSAEK outcomes.

Purpose of the Study:

  • To identify factors associated with graft rejection following DSAEK.
  • To analyze the impact of donor cornea preservation time (PT) on rejection rates.
  • To determine the relationship between rejection and endothelial cell loss (ECL).

Main Methods:

  • A multicenter randomized clinical trial (CPTS) involving 1330 eyes undergoing DSAEK.
  • Eyes were randomized to donor cornea preservation times of 0-7 days or 8-14 days.
  • Multivariable Cox models were used to identify factors associated with graft rejection over a 3-year follow-up.

Main Results:

  • The cumulative probability of definite graft rejection was 3.6%.
  • Younger recipient age was significantly associated with an increased risk of graft rejection.
  • Preservation time, donor-recipient sex mismatch, and other factors were not associated with rejection.

Conclusions:

  • Graft rejection is infrequent after DSAEK, especially in older populations.
  • Younger recipient age is a key risk factor for DSAEK graft rejection.
  • While rejection increases endothelial cell loss, it is not a primary cause of graft failure.