Influence of advanced recipient and donor age on the outcome of corneal transplantation. Australian Corneal Graft Registry

Abstract

Aims: The aims of this study were to examine the influence of advanced recipient and donor age on the long term outcome of corneal transplantation.

Methods: Records of 1036 penetrating corneal grafts in recipients aged > or = 80 years at surgery (defined as the elderly subset) and 8092 donor corneas used for transplantation were obtained from the Australian Corneal Graft Register database, Kaplan-Meier graft survival plots were compared using log rank statistics.

Results: Elderly recipients constituted 15% of the recipient pool. The major indication for corneal transplantation in the elderly was bullous keratopathy. Graft survival fell with increasing recipient age (p < 0.00001); the major cause of graft failure was rejection (33%). The desired outcome in 51% of cases was to improve vision and in 42% of cases to relieve pain; 23% of elderly recipients achieved a Snellen acuity of 6/18 or better in the grafted eye and 66% recorded improved acuity after transplantation. Elderly recipients suffered more complications and comorbidities in the grafted eye than did younger recipients. Donor age (stratified in 10 year intervals) did not influence corneal graft survival significantly (p = 0.10).

Conclusions: Elderly graft recipients fared less well after corneal transplantation than did younger recipients, but outcomes in terms of long term graft survival and visual rehabilitation were still good. Donor age did not affect graft survival.

Figure 1

Distribution of recipient ages at graft in a cohort of 7741 patients undergoing penetrating corneal transplantation. NR = not recorded.

Figure 2

Number of corneal grafts in elderly recipients aged ⩾80 years at the time of graft compared with those age <80 years, showing the influence of calendar years in which the grafts were performed.

Figure 3

Kaplan-Meier corneal graft survival plots stratified according to recipient age at graft. For each curve, n = number initially at risk.

Figure 4

Kaplan-Meier graft survival plots in recipients aged ⩾80 years at graft, stratified according to the most common indications for transplantation in this subset. For each curve, n = number initially at risk. Scars = corneal scars and opacities; ABK = aphakic bullous keratopathy; PBK = pseudophakic bullous keratopathy.

Figure 5

Snellen acuity at the time of most recent follow up for elderly corneal graft recipients (⩾80 years) and for younger recipients (<80 years). CF = counting fingers at 1 metre; HM = hand movements; LP = light perception; NLP = no light perception; NR= not recorded.

Figure 6

Number of lines of change on the Snellen chart at the time of most recent follow up, compared with Snellen acuity immediately before corneal transplantation, for elderly corneal graft recipients (⩾80 years).

Figure 7

Number of penetrating and lamellar corneal grafts performed using tissue from corneal donors of different ages, stratified in 10 year intervals. NR = not recorded.