Journal article
Factors Associated With Graft Rejection in the Cornea Preservation Time Study
American journal of ophthalmology, Vol.196, pp.197-207
12/01/2018
DOI: 10.1016/j.ajo.2018.10.005
PMCID: PMC6258266
PMID: 30308200
Abstract
To identify factors related to graft rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS).
Cohort study within a multicenter randomized clinical trial.
A total of 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 3 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.
Cumulative probability of definite graft rejection was 3.6% (99% confidence interval 2.5%-5.3%). Younger recipient age was associated with graft rejection (P < .001; hazard ratio: 0.53 [0.33, 0.83] per decade). PT, donor-recipient sex mismatch, recipient diagnosis, recipient race, graft size, discontinuation of topical corticosteroids and immune-modulators, prior immunizations within 3 months, and prior glaucoma surgery were not associated with rejection (P > .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 = .03). Twelve of 44 eyes (27%) with definite graft rejection subsequently failed, comprising 15% of the 79 failures in the CPTS.
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.
Details
- Title: Subtitle
- Factors Associated With Graft Rejection in the Cornea Preservation Time Study
- Creators
- R Doyle Stulting - Woolfson Eye InstituteJonathan H Lass - Case Western Reserve UniversityMark A Terry - Devers Eye Institute, Portland, Oregon, USABeth Ann Benetz - Case Western Reserve UniversityNathan J Cohen - Jaeb Center for Health ResearchAllison R Ayala - Jaeb Center for Health ResearchMaureen G Maguire - University of PennsylvaniaChristopher Croasdale - SSM Health - Dean Medical Group, Madison, Wisconsin, USAYassine J Daoud - Johns Hopkins UniversitySteven P Dunn - Michigan Cornea Consultants, P.C., Southfield, Michigan, USAKenneth M Goins - University of IowaPankaj C Gupta - Case Western Reserve UniversityMarian S Macsai - Northshore University Health System, Glenview, Illinois, USAShahzad I Mian - University of MichiganSudeep Pramanik - Mid Atlantic Cornea Consultants, Baltimore, Maryland, USAJennifer Rose-Nussbaumer - University of California, San FranciscoJonathan C Song - University of Southern California Roski Eye Institute, Los Angeles, California, USAWalter J Stark - Johns Hopkins UniversityAlan Sugar - University of MichiganDavid D Verdier - Verdier Eye Center, Grand Rapids, Michigan, USALoretta B Szczotka-Flynn - Case Western Reserve UniversityCornea Preservation Time Study Group
- Resource Type
- Journal article
- Publication Details
- American journal of ophthalmology, Vol.196, pp.197-207
- DOI
- 10.1016/j.ajo.2018.10.005
- PMID
- 30308200
- PMCID
- PMC6258266
- NLM abbreviation
- Am J Ophthalmol
- ISSN
- 0002-9394
- eISSN
- 1879-1891
- Grant note
- U10 EY020797 / NEI NIH HHS U10 EY020798 / NEI NIH HHS
- Language
- English
- Date published
- 12/01/2018
- Academic Unit
- Ophthalmology and Visual Sciences
- Record Identifier
- 9984806509902771
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