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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
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.Results
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.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.
SUBMITTER: Stulting RD
PROVIDER: S-EPMC6258266 | biostudies-literature | 2018 Dec
REPOSITORIES: biostudies-literature
Stulting R Doyle RD Lass Jonathan H JH Terry Mark A MA Benetz Beth Ann BA Cohen Nathan J NJ Ayala Allison R AR Maguire Maureen G MG Croasdale Christopher C Daoud Yassine J YJ Dunn Steven P SP Goins Kenneth M KM Gupta Pankaj C PC Macsai Marian S MS Mian Shahzad I SI Pramanik Sudeep S Rose-Nussbaumer Jennifer J Song Jonathan C JC Stark Walter J WJ Sugar Alan A Verdier David D DD Szczotka-Flynn Loretta B LB
American journal of ophthalmology 20181009
<h4>Purpose</h4>To identify factors related to graft rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS).<h4>Design</h4>Cohort study within a multicenter randomized clinical trial.<h4>Methods</h4>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 ...[more]