Clinical Predictors of Endothelial Damage in Internationally Transported Donor Corneas

To identify clinical factors influencing corneal endothelial damage during international transportation by evaluating the condition of donor corneas upon arrival in Japan, representing the real-world scenario faced by importing countries.

We analyzed 194 donor corneas (from 102 donors; mean age 29.8 years) transported from 3 US eye banks to Japan. All corneas underwent trypan blue staining (0.4%) to quantify endothelial damage, with damaged areas manually traced and analyzed using custom Python-based image analysis. Univariate and multivariate analyses using generalized linear mixed models identified predictors of endothelial damage, with donors stratified into high- and low-damage groups based on median staining rates.

Most corneas (62.4%) showed minimal damage (<2% trypan blue-positive area), whereas 4.1% exhibited extensive damage (>10%). Multivariate analysis identified the following 4 independent predictors of increased endothelial damage: eye bank source (eye bank C vs. A: odds ratio [OR] 4.67, 95% confidence interval [CI] 1.08 to 20.07, P = 0.039), younger donor age (≥31 vs. <31 years: OR 0.40, 95% CI 0.17-0.93, P = 0.033), donor race (Black vs. White: OR 3.44, 95% CI 1.28-9.25, P = 0.014), and cause of death (gastrointestinal disorder vs. cardiovascular disease: OR 4.92, 95% CI 1.35-17.95, P = 0.016; malignant tumor vs. cardiovascular disease: OR 14.32, 95% CI 3.01-68.13, P <0.001). Neither time from death to donation nor preservation duration predicted damage, validating current temporal protocols.

This study identifies real-world factors influencing endothelial integrity in internationally transported donor corneas, addressing an underrecognized aspect of global eye banking.