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Differential effects of primary disease and corneal vascularisation on corneal transplant rejection and survival
  1. Daniel Sibley1,
  2. Cathy L Hopkinson2,
  3. Stephen J Tuft1,
  4. Stephen B Kaye3,
  5. Daniel F P Larkin1
  6. On behalf of the National Health Service Blood and Transplant Ocular Tissue Advisory Group and contributing ophthalmologists (OTAG Study 26)
  1. 1 Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2 Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, UK
  3. 3 Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to Dr Daniel F P Larkin, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; Frank.Larkin{at}


Aims To investigate the relative risk of pretransplant corneal vascularisation on rate of rejection and graft failure within 5 years of surgery when categorised by indication for transplantation.

We analysed all adults recorded in the UK transplant registry who had a first cornea transplant for keratoconus (KC), pseudophakic bullous keratopathy (PBK) or previous infection (viral/bacterial/fungal/protozoan) between 1999 and 2017. We analysed the number of quadrants of the recipient cornea vascularised before transplant and type of vascularisation, the interval post-transplant to rejection, if any, and the outcome at 5 years post-transplant. Risk factors for rejection and transplant failure were modelled by multivariable risk-adjusted Cox regression.

Results Corneal vascularisation was recorded in 10%, 25% and 67% of patients with KC, PBK and infection, respectively. Individuals with PBK had an increased hazard of transplant rejection only when there were more than two quadrants of vascularisation (HR 1.5, p=0.004) when either superficial and/or deep vascularisation was present (HR 1.3 and 1.4, respectively, p=0.004). Individuals who had a transplant for previous infection had an increased hazard of rejection with four quadrants of vascularisation (HR 1.6, p=0.003). There was no risk-adjusted increase in transplant failure associated with vascularisation in any group. There was weak evidence of reduction in risk of rejection and/or failure associated with lamellar compared with penetrating transplantation in KC and PBK in vascularised recipient corneas.

Conclusion Vascularisation is a risk factor for corneal allograft rejection within 5 years. The indication for transplantation has a clinically significant effect on the magnitude of this risk.

  • cornea
  • eye (tissue) banking
  • neovascularisation

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  • Contributors Study concept and design: DS, CLH, DFPL. Acquisition, analysis or interpretation of data: DS, CLH, DFPL. Drafting of the manuscript: DS, CLH, DFPL. Critical revision of the manuscript for important intellectual content: SBT, SBK, DFPL. Statistical analysis: CLH. Study supervision: DFPL.

  • Funding This research was supported by the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre and NIHR Moorfields Clinical Research Facility, based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.