Article Text

other Versions

PDF
The impact of donor age and endothelial cell density on graft survival following penetrating keratoplasty
  1. M J Wakefield1,
  2. W J Armitage2,3,
  3. M N A Jones4,
  4. S B Kaye5,
  5. D F P Larkin6,
  6. D Tole4,7,
  7. J Prydal1
  8. on behalf of the National Health Service Blood and Transplant Ocular Tissue Advisory Group (OTAG Audit Study 19)
  1. 1Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
  2. 2National Health Service Blood and Transplant, Bristol Eye Bank, Bristol, UK
  3. 3School of Clinical Sciences, University of Bristol, Bristol, UK
  4. 4National Health Service Blood and Transplant, Bristol, UK
  5. 5St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  6. 6Moorfields Eye Hospital, London, UK
  7. 7Bristol Eye Hospital, Bristol, UK
  1. Correspondence to Dr Matthew J Wakefield, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Matthew.wakefield{at}uhl-tr.nhs.uk

Abstract

Purpose To determine if donor age and preoperative endothelial cell density (ECD) affect corneal endothelial failure following penetrating keratoplasty (PK).

Methods Preoperative and postoperative data for PKs performed in the UK between April 1999 and March 2012 were analysed. Donor age was split into three groups (0–60, 61–75 and >75 years) and donor ECD was split into three groups (≤2400, 2401–2600 and >2600 cells/mm2). Cox proportional hazards regression was used to determine whether the selected subgroups of donor age and donor ECD have an impact on endothelial failure and a systematic analysis of the interaction between donor ECD and donor age was conducted. The analysis was stratified for primary corneal diagnosis (Fuchs endothelial dystrophy (FED), pseudophakic bullous keratopathy (PBK) and other) and corrected for potentially confounding factors (human leukocyte antigen matching, donor trephine diameter, deep vascularisation, the occurrence of reversible rejection episodes and receipt of systemic antiviral medication, long-term steroids or other immunosuppressive agents).

Results A total of 9415 patients, from the National Health Service Blood and Transplant UK Transplant Registry, who received their first PK for visual reasons were included in this study. The overall 5-year graft survival rate due to endothelial failure was 89%. Survival rates in recipients with FED, PBK and ‘all other indications’ were 95%, 83% and 89%, respectively. Our analysis shows that donor ECD did not affect outcome following corneal graft within the preselected categories, irrespective of diagnosis and after allowing for any potential confounding factors. Furthermore, HRs for each level of donor ECD, relative to >2600 cells/mm2, for each combination of age group and indication, were not statistically significant.

Conclusions We were unable to detect a significant effect of donor age, up to 90 years, and preoperative donor ECD, above the lower limit of 2200 cells/mm2, on endothelial failure at 5 years following PK.

  • Cornea
  • Eye (Tissue) Banking
  • Treatment Surgery
  • Epidemiology

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • At a glance
    Keith Barton Jost Jonas James Chodosh