Clinical and epidemiological factors affecting donor corneal endothelial cell density

The limited availability of corneal donors poses a significant challenge to meeting transplantation demands. Factors such as advanced donor age and prior cataract surgery are known to reduce donor corneal quality, yet a predictive system for resource optimisation is lacking. This study aimed to identify clinical and epidemiological factors affecting donor corneal endothelial cell density (ECD) in an Israeli eye bank, focusing on the impact of short death-to-retrieval time (DRT).

A retrospective analysis was conducted on 611 donor corneas retrieved at Hadassah Medical Center between 2018 and 2022. Donor age, sex, medical history, cause of death and DRT were evaluated for their association with adequate ECD (defined locally as ≥2400 cells/mm²), using univariate and multivariable analyses.

The study included 611 corneas from 310 donors, with a mean ECD of 2624 cells/mm² (SD 519); 76.3% (n=466) met the local adequacy threshold. The mean donor age was 64.4 years (SD 15.3), and median DRT was 2 hours and 29 minutes. In univariate analysis, lower ECD was associated with advanced age, prior cataract surgery and systemic conditions such as diabetes mellitus, hypertension and ischaemic heart disease. In multivariable analysis, only advanced age (adjusted OR 0.96 per year) and phakic lens status (adjusted OR 14.25) remained significant. A non-significant trend toward higher adequacy was observed in corneas retrieved within 4 hours of death (82.5% vs 75%; p=0.12).

Advanced donor age and prior cataract surgery were the strongest predictors of lower ECD. The potential benefit of shorter DRT on corneal quality warrants further investigation. These findings are subject to limitations, including reliance on a local adequacy threshold (≥2400 cells/mm²) and missing DRT data in part of the cohort.