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Donor Diabetes Mellitus Severity and Corneal Transplant Suitability in a US Eye Bank Donor Population

Rand, Gabriel M. MD*; Polla, Daniel J. MD*; Patel, Sejal H. MD*; Gore, Patrick K. RN, CEBT; Forest-Smith, Lynn CEBT; Livesay, Tina M. CEBT; Chuck, Roy S. MD, PhD*

doi: 10.1097/ICO.0000000000002047
Clinical Science
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Purpose: To determine whether donor diabetes mellitus (DM) severity is associated with differences in endothelial cell density (ECD) and surgically unsuitable tissue.

Methods: Raw data were obtained from Saving Sight Eye Bank (Kansas City, MO) including 10,454 donated eyes from 5346 eligible donors from July 2014 through May 2017. Donors were grouped into 5 categories by their insulin use and the presence of microvascular end-organ complications. The categories were non-DM (NDM), noninsulin-dependent DM without complications (NIDDMnc), noninsulin-dependent DM with complication (NIDDMc), insulin-dependent DM without complications, and insulin-dependent DM with complication. Outcome variables included ECD and tissue transplant suitability. Mixed effects models were used to adjust for the random effect of repeated measures and fixed effects of donor age, race, lens status, and death to refrigeration and death to preservation times. Interaction effects of DM severity group and donor age and DM severity group and lens status were included in the models.

Results: One thousand six hundred eighty-four (32.1%) donors had a diagnosis of DM. Six hundred fifty-eight donors were in the NIDDMnc group, 225 in the NIDDMc group, 404 in the insulin-dependent DM without complication group, and 397 in the insulin-dependent DM with complication group. Compared with non-DM, donors with DM were older (P < 0.001) and more likely to be pseudophakic (P < 0.001). DM severity groups did not affect adjusted ECD at mean donor age. There was no statistically significant ECD interaction between DM severity group and lens status. There was a statistically significant ECD crossover interaction with NIDDMnc and donor age (P < 0.001). In phakic eyes, NIDDMc was associated with a statistically significantly lower odds of transplant suitability (odds ratio 0.62, P = 0.006).

Conclusions: DM severity does not affect lowering adjusted ECD at mean donor age. DM severity and pseudophakia were not associated with lower adjusted ECD. NIDDMnc was associated with an attenuation of the age-dependent decrease in ECD. NIDDMc was associated with decreased transplant suitability in phakic eyes. Future studies should include age, lens status, and interaction effects in their models of ECD and transplant suitability.

*Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and

Saving Sight Eye Bank, Kansas City, MO.

Correspondence: Roy S. Chuck, MD, PhD, Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, 3332 Rochambeau Avenue, Bronx, New York, NY 10467 (e-mail: rchuck@montefiore.org).

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

Received January 16, 2019

Received in revised form May 19, 2019

Accepted May 21, 2019

Online date: July 3, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.