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Transplant rejection following endothelial keratoplasty and penetrating keratoplasty in the United Kingdom: Incidence and survival

Lookup NU author(s): Dr Gustavo Figueiredo, Professor Francisco FigueiredoORCiD

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Abstract

© 2015 Elsevier Inc. All rights reserved. Purpose To investigate the incidence and outcome of cornea transplant rejection following endothelial keratoplasty (EK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK). Design Multicenter cohort study. Methods Patients registered on the United Kingdom Transplant Registry (UKTR) who had an EK or PK for FED or PBK between April 1, 2005 and March 31, 2011 were included. Data were collected from UKTR forms at 1 and 2 years. Postoperative steroid use varies between surgeons and cannot be captured in this reporting system. Rejection events were identified as those recorded as endothelial rejection. Results A total of 3486 corneal transplants were undertaken: 1973 for FED, 1513 for PBK. For FED, 2-year rejection-free survival was 93% (95% confidence interval [CI] 90%-94%) for PK and 94% (95% CI 92%-96%) for EK (P =.3). In transplants that had a rejection episode, 50% of PKs (17) and 60% of EKs (15) subsequently failed. For PBK, 2-year rejection-free survival for PK was 88% (95% CI 86%-90%) and 90% (95% CI 86%-92%) for EK (P =.6). In transplants that had a rejection episode, 85% of PKs (41) and 76% of EKs (22) subsequently failed. Inflammation (ie, conjunctival injection, presence of keratic precipitates and intraocular signs) at the time of surgery for patients with FED was significant for developing rejection: 3.5 times greater compared with those with no inflammation (P =.02). Conclusions There is no significant difference in rejection-free survival between EK and PK for FED or PBK. The presence of inflammation is an important risk factor, and attention to its control before and following surgery is important.

Publication metadata

Author(s): Figueiredo GSM, Jones MNA, Krishna Y, Figueiredo FCD, Larkin DFP, Kaye SB

Publication type: Article

Publication status: Published

Journal: American Journal of Ophthalmology

Year: 2015

Volume: 160

Issue: 3

Pages: 416-421

Print publication date: 01/09/2015

Online publication date: 24/06/2015

Acceptance date: 16/06/2015

ISSN (print): 0002-9394

ISSN (electronic): 1879-1891

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.ajo.2015.06.012

DOI: 10.1016/j.ajo.2015.06.012

PubMed id: 26116262

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