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Ocular Surface Stem Cell Transplantation Rejection: Incidence, Characteristics, and Outcomes

Ang, Andrea Y. MBBS, MPH; Chan, Clara C. MD, FRCSC; Biber, Joseph M. MD; Holland, Edward J. MD

doi: 10.1097/ICO.0b013e318255eac4
Clinical Science

Purpose: To describe the incidence, characteristics, risk factors, treatment, and outcomes of ocular surface stem cell transplantation (OSST) rejection.

Methods: A chart review of patients who had OSST at a single institution between 1998 and 2010 was performed. Data were collected on patient demographics, type of OSST procedure, duration of immunosuppression, and rejection characteristics. Main outcome measures were ocular surface stability and improvement in best-corrected visual acuity.

Results: Two hundred twenty-two eyes of 158 patients were included with mean follow-up of 62.7 months (range, 12.0–158.3 months). The most common indications for OSST were aniridia (46.4%), chemical/thermal injury (22.1%), and Stevens–Johnson syndrome (12.2%). The most common procedures performed were keratolimbal allograft (KLAL) alone (80.6%) and combined living-related conjunctival allograft (lr-CLAL)–KLAL (11.3%). Mean time on immunosuppression was 44.3 months (range, 7.6–138.2 months). Severe rejection occurred in 43 eyes (19.4%) with mean time to rejection being 15.2 months (range, 0.2–93.1 months). Low-grade rejection occurred in 26 eyes (11.7%) with mean time to rejection being 26.2 months (range, 1.3–64.9 months). At the final follow-up, 36.6% of eyes in the rejection group achieved a stable ocular surface compared with 71.9% of eyes in the nonrejection group (P < 0.0001). Risk factors associated with increased risk of rejection were younger age (P < 0.0001), KLAL alone (P = 0.049), and noncompliance with immunosuppression (P = 0.047).

Conclusions: Ocular surface outcomes for patients with OSST rejection are poor, with the majority of patients having failed ocular surfaces despite treatment with increased immunosuppression and repeat OSST. It is critical for success that OSST patients are closely monitored for rejection and for compliance with immunosuppression.

*Cincinnati Eye Institute, Cincinnati, OH

Department of Ophthalmology Vision Sciences, University of Toronto, Toronto, Ontario, Canada

Horizon Eye Care, Charlotte, NC

Department of Ophthalmology, University of Cincinnati, Cincinnati, OH.

Reprints: Edward J. Holland, Cincinnati Eye Institute, 580 South Loop Rd, Suite 200, Edgewood, KY 41017 (e-mail:

A. Y. Ang is supported by a University of Western Australia Medical Research Fellowship and the Faculty of Medicine, Dentistry, and Health Sciences.

The authors have no financial or conflicts of interest to disclose.

Received February 14, 2012

Accepted March 15, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.