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Randomized Controlled Trial
. 2018 Dec:196:197-207.
doi: 10.1016/j.ajo.2018.10.005. Epub 2018 Oct 9.

Factors Associated With Graft Rejection in the Cornea Preservation Time Study

R Doyle Stulting  1 , Jonathan H Lass  2 , Mark A Terry  3 , Beth Ann Benetz  4 , Nathan J Cohen  5 , Allison R Ayala  5 , Maureen G Maguire  6 , Christopher Croasdale  7 , Yassine J Daoud  8 , Steven P Dunn  9 , Kenneth M Goins  10 , Pankaj C Gupta  4 , Marian S Macsai  11 , Shahzad I Mian  12 , Sudeep Pramanik  13 , Jennifer Rose-Nussbaumer  14 , Jonathan C Song  15 , Walter J Stark  8 , Alan Sugar  12 , David D Verdier  16 , Loretta B Szczotka-Flynn  4 ; Cornea Preservation Time Study Group
Affiliations
Randomized Controlled Trial

Factors Associated With Graft Rejection in the Cornea Preservation Time Study

R Doyle Stulting et al. Am J Ophthalmol. 2018 Dec.

Abstract

Purpose: To identify factors related to graft rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS).

Design: Cohort study within a multicenter randomized clinical trial.

Methods: A total of 1330 eyes of 1090 subjects undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0-7 days (n = 675) or 8-14 days (n = 655) and followed for 3 years. Central endothelial cell density (ECD) was determined by a central image analysis reading center. Multivariable Cox models adjusted for PT, recipient diagnosis, and surgeon effect were used to identify factors associated with rejection.

Results: Cumulative probability of definite graft rejection was 3.6% (99% confidence interval 2.5%-5.3%). Younger recipient age was associated with graft rejection (P < .001; hazard ratio: 0.53 [0.33, 0.83] per decade). PT, donor-recipient sex mismatch, recipient diagnosis, recipient race, graft size, discontinuation of topical corticosteroids and immune-modulators, prior immunizations within 3 months, and prior glaucoma surgery were not associated with rejection (P > .01). Among clear grafts with an ECD measurement at baseline and 3 years (n = 913), endothelial cell loss (ECL) was greater in eyes that experienced a rejection episode (n = 27) than in those that did not (n = 886) (48% vs 38%, P = .03). Twelve of 44 eyes (27%) with definite graft rejection subsequently failed, comprising 15% of the 79 failures in the CPTS.

Conclusions: Graft rejection is uncommon after DSAEK and more likely with younger age, in a study cohort mostly > 50 years old. Rejection increases ECL, but it is not a leading cause of DSAEK failure.

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Figures

Figure 1.
Figure 1.
Cumulative incidence for the first definite graft rejection episode in the Cornea Preservation Time Study
Figure 2.
Figure 2.
Endothelial cell density after the first definite graft rejection episode vs. pre-operative endothelial cell density
See this image and copyright information in PMC

References

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