Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty in the United States : Cornea

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Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty in the United States

Fliotsos, Michael J. MD*; Campbell, Jack A. BA*; Li, Ximin MS; Engstrom, Marie B.; Stoeger, Christopher G. CEBT, MBA; McClory, Cathy§; Titus, Michael S. CEBT§; Johnson, Patrick BBA; Johnston, Kara B. CEBT, BA; Fischer, Tim; Brooks, Lisa K. BS, CTBS, CEBT; Montoya, Monty M. MBA**; Glasser, David B. MD*; Akpek, Esen Karamursel MD*; Srikumaran, Divya MD*

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Cornea 41(7):p 833-839, July 2022. | DOI: 10.1097/ICO.0000000000002831



The purpose of this study was to report trends in the prevalence of early graft failure after endothelial keratoplasty in the United States.


Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft volumes were collected from records maintained by 6 major eye banks in the United States from January 1, 2013, to December 31, 2018. The prevalence and presumed cause of early graft failures (defined as a graft with persistent edema or regrafted within 8 weeks after keratoplasty) each year were sourced from surgeon-reported adverse events. Failed graft cases from the 3 eye banks were compared with nonfailures at the donor and recipient levels to perform subset analysis of factors associated with early graft failure.


A total of 51,887 endothelial keratoplasty tissues were distributed during the study period; 72% were DSAEK grafts. The total number of early graft failures reported was 168 of 14,284 (1.18%) for DMEK and 322 of 37,603 (0.86%) for DSAEK. Early DMEK failures decreased from 2013 (7.69%) to 2018 (0.68%). In generalized linear mixed model analyses adjusting for donor tissue characteristics, recipient age, and diagnosis, an association of borderline significance was found between higher donor age and early failure [odds ratio (95% confidence interval): 1.03 (1.00–1.05); unit change of 1 yr] and DSAEK [odds ratio 1.02 (1.00–1.04); unit of change 1 yr] cases.


The proportion of early graft failures in DMEK decreased over time and was comparable with failure rates in DSAEK at the end of the study period. The surgical learning curve might have played a role.

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