Conclusions of the corneal transplant follow up study
a University
of Leeds Institute of Epidemiology and Health Services Research, Leeds, b MRC Biostatistics Unit, Institute of Public
Health, Cambridge, c University of Bristol
Department of Transplantation Sciences, Southmead Health Services,
Bristol, d University of Bristol
Department of Ophthalmology, Bristol Eye Hospital, Bristol, e United Kingdom Transplant Support
Service Authority, Bristol
Correspondence to: Professor B A Bradley, Department of Transplantation Sciences, Professorial Unit, Southmead Health Services, Bristol BS10 5NB.
Accepted for publication 11 March 1997
AIM
On the basis of finalised data from the
Corneal Transplant Follow up Study to identify and quantify factors
influencing corneal graft outcome in terms of graft survival,
rejection, visual acuity, and astigmatism.
METHODSMultifactorial analysis of 2777 grafts
registered by the UK Transplant Support Service from July 1987 to June 1991.
RESULTSSeveral recipient factors influencing
graft survival, rejection, and visual acuity were identified, but no
donor factors. Of the operative factors amenable to change, mixed
suturing was associated with reduced graft survival, and larger grafts
with increased risk of rejection but better visual acuity when
surviving. There was increased risk of rejection with poor matching at
HLA class I antigens, but mismatched HLA-DR grafts suffered less
rejection than those with zero HLA-DR mismatches. Recipient age below
10 years was associated with increased risk of both rejection and graft
failure. However, whereas increasing age above 10 years was not
associated with differential graft survival, it was significantly associated with decreasing risk of rejection.
CONCLUSIONSWhile confirming possible benefits of
HLA-A and B matching, the expense and delay involved in awaiting
matched HLA-DR tissue is unlikely to be justified. Other donor factors
are unrelated to graft outcome following screening of tissue by eye
banks. The highest rates of graft failure and rejection happen in the
early postoperative period, and factors influencing visual outcome are also apparent at this stage.
© 1997 by British Journal of Ophthalmology
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