1. Factors Associated With Graft Rejection in the Cornea Preservation Time Study
- Author
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Maureen G. Maguire, Jonathan H. Lass, Allison R Ayala, David D. Verdier, Christopher R. Croasdale, Nathan J Cohen, R. Doyle Stulting, Pankaj C Gupta, Shahzad I. Mian, Mark A. Terry, Marian S. Macsai, Alan Sugar, Sudeep Pramanik, Walter J. Stark, Jennifer Rose-Nussbaumer, Jonathan C. Song, Kenneth M. Goins, Loretta B Szczotka-Flynn, Steven P. Dunn, Beth Ann Benetz, and Yassine J. Daoud
- Subjects
0301 basic medicine ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Article ,law.invention ,Corneal Diseases ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,Cornea ,Medicine ,Humans ,Aged ,Aged, 80 and over ,Graft rejection ,business.industry ,Proportional hazards model ,Age Factors ,Organ Preservation ,Middle Aged ,Confidence interval ,Surgery ,Endothelial cell density ,Ophthalmology ,030104 developmental biology ,medicine.anatomical_structure ,Cohort ,030221 ophthalmology & optometry ,Female ,business ,Descemet Stripping Endothelial Keratoplasty ,Cohort study - Abstract
PURPOSE: To identify factors related to graft rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS). DESIGN: Cohort study within a multicenter randomized clinical trial. METHODS: 1330 eyes of 1090 subjects undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0–7 days (N=675) or 8–14 days (N=655) and followed for three years. Central endothelial cell density (ECD) was determined by a central image analysis reading center. Multivariable Cox models adjusted for PT, recipient diagnosis, and surgeon effect were used to identify factors associated with rejection. RESULTS: Cumulative probability of definite graft rejection was 3.6% (99% CI 2.5% to 5.3%). Younger recipient age was associated with graft rejection [p0.01). Among clear grafts with an ECD measurement at baseline and 3 years (N=913), endothelial cell loss (ECL) was greater in eyes that experienced a rejection episode (N=27) than in those that did not (N=886) (48% vs 38%, p=0.03). Twelve of 44 eyes (27%) with definite graft rejection subsequently failed, comprising 15% of the 79 failures in the CPTS. CONCLUSIONS: Graft rejection is uncommon after DSAEK and more likely with younger age, in a study cohort mostly > 50 years old. Rejection increases ECL, but it is not a leading cause of DSAEK failure.
- Published
- 2018