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Updated: Oct 10, 2026
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Predictors of long-term graft survival after descemet membrane endothelial keratoplasty
Dana Barequet1, Mobin Abdi2, Ae Ra Kee2
1Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, 399 Bathurst St, 6th Floor East Wing, Toronto, ON, M5T 2S8, Canada. danabarequet@gmail.com.
Purpose:
To identify predictors of long-term graft survival following Descemet membrane endothelial keratoplasty (DMEK), focusing on recipient, donor, and early postoperative graft characteristics.
Methods:
This retrospective cohort study included 356 eyes from 246 patients undergoing DMEK with a minimum follow-up of 5 years (mean, 8.0 ± 2.2 years). Graft survival was evaluated using Kaplan-Meier analysis. Multivariable Cox proportional hazards models with clustered standard errors assessed baseline recipient and surgical predictors, donor characteristics, and early postoperative graft characteristics.
Results:
During follow-up, 99 graft failures (27.8%) occurred. Graft survival differed by indication (log-rank p < 0.001), with failure rates of 7.4% in FED, 54.0% in BK, 57.6% in failed PKP, 46.4% in failed DSAEK, and 66.7% in repeat DMEK. In multivariable analysis, compared with FED, BK (HR 2.69, p = 0.014), failed PKP (HR 4.78, p < 0.001), failed DSAEK (HR 3.12, p = 0.013), and repeat DMEK (HR 4.40, p = 0.003) were associated with increased risk of graft failure. Prior glaucoma drainage device surgery was also independently associated with failure (HR 2.44, p = 0.041). Donor characteristics, including donor age, endothelial cell density, donor-recipient sex mismatch, storage-to-use time, and graft diameter, were not independently associated with graft survival. In the early postoperative model, recipient factors remained dominant predictors, whereas graft detachment, rebubbling, and 6-month endothelial cell density were not independently associated with failure. However, Kaplan-Meier analysis demonstrated worse survival in eyes with lower endothelial cell density and greater endothelial cell loss at 6 months.
Conclusions:
Long-term graft survival after DMEK is primarily determined by recipient pathology and ocular comorbidity rather than donor characteristics. Early postoperative endothelial behavior is associated with survival patterns but does not independently predict graft failure after adjustment. These findings highlight the importance of recipient risk stratification and early endothelial monitoring in optimizing long-term outcomes after DMEK.
