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Effect of Donor and Recipient Factors on Corneal Graft Rejection

Stulting, R. Doyle MD, PhD; Sugar, Alan MD; Beck, Roy MD, PhD; Belin, Michael MD; Dontchev, Mariya MPH; Feder, Robert S. MD; Gal, Robin L. MSPH; Holland, Edward J. MD; Kollman, Craig PhD; Mannis, Mark J. MD; Price, Francis Jr MD; Stark, Walter MD; Verdier, David D. MDfor the Cornea Donor Study Investigator Group

doi: 10.1097/ICO.0b013e31823f77f5
Clinical Science

Purpose: To assess the relationship between donor and recipient factors and corneal allograft rejection in eyes that underwent penetrating keratoplasty in the Cornea Donor Study.

Methods: Overall, 1090 subjects undergoing corneal transplantation for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 5 years. Associations of baseline recipient and donor factors with the occurrence of a probable or definite rejection event were assessed in univariate and multivariate proportional hazards models.

Results: Eyes with pseudophakic or aphakic corneal edema (n = 369) were more likely to experience a rejection event than eyes with Fuchs dystrophy (n = 676) [34% ± 6% vs. 22% ± 4%; hazard ratio = 1.56; 95% confidence interval (CI), 1.21–2.03]. Among eyes with Fuchs dystrophy, a higher probability of a rejection event was observed in phakic posttransplant eyes compared with those that underwent cataract extraction with or without intraocular lens implantation during penetrating keratoplasty (29% vs. 19%; hazard ratio = 0.54; 95% CI, 0.36–0.82). Female recipients had a higher probability of a rejection event than male recipients (29% vs. 21%; hazard ratio = 1.42; 95% CI, 1.08–1.87) after controlling for the effect of preoperative diagnosis and lens status. Donor age and donor recipient ABO compatibility were not associated with rejection.

Conclusions: There was a substantially higher graft rejection rate in eyes with pseudophakic or aphakic corneal edema compared to that in eyes with Fuchs dystrophy. Female recipients were more likely to have a rejection event than male recipients. Graft rejection was not associated with donor age.

*Emory Eye Center, Emory University, Atlanta, GA

W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI

Jaeb Center for Health Research, Tampa, FL

§Cornea Consultants of Albany, Albany, NY

Northwestern University, Chicago, IL

Cincinnati Eye Institute, Cincinnati, OH

**Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA

††Price Vision Group, Indianapolis, IN

‡‡The Johns Hopkins University School of Medicine, Baltimore, MD

§§Verdier Eye Center, P.C., Grand Rapids, MI. Dr. Stulting is now with the Stulting Research Center at Woolfson Eye Institute, Atlanta, GA. Dr. Belin is now with the Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ.

Reprints: R. Doyle Stulting, c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647; (e-mail:

Supported by cooperative agreements with the National Eye Institute, National Institutes of Health, Department of Health and Human Services (EY12728 and EY12358). Additional support provided by the Eye Bank Association of America, Bausch & Lomb, Inc, Tissue Banks International, Vision Share, Inc, San Diego Eye Bank, The Cornea Society, Katena Products, Inc, ViroMed Laboratories, Inc, Midwest Eye-Banks (Michigan Eye-Bank, Illinois Eye-Bank), Konan Medical Corp, Eye Bank for Sight Restoration, SightLife, Sight Society of Northeastern New York (Lions Eye Bank of Albany), Lions Eye Bank of Oregon.

A listing of the Cornea Donor Study Investigator Group, including clinical site investigators, eye bank staff, coordinating center staff, specular microscopy reading center staff, and committees, has been previously published online.

The following CDS Publications Committee members independently reviewed and approved this manuscript for submission: Jonathan I. Macy, MD, Christopher J. Rapuano, MD, Patricia W. Smith, MD.

The authors state that they have no proprietary interest in the products named in this article.

Received May 9, 2011

Accepted July 3, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.