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Tacrolimus immunosuppression in high-risk corneal grafts
  1. A Joseph1,
  2. D Raj1,
  3. V Shanmuganathan1,
  4. R J Powell2,
  5. H S Dua1
  1. 1Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
  2. 2Department of Immunology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
  1. Correspondence to: H S Dua Division of Ophthalmology and Visual Sciences, B Floor, Eye, ENT Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK; harminder.dua{at}


Background: Unlike the immune privilege enjoyed by low-risk corneal grafts, high-risk corneal grafts experience rejection rates comparable to liver and kidney transplants. Systemic immunosuppression reduces the risk of rejection in high-risk corneal grafts.

Methods: Systemic tacrolimus, a specific T cell inhibitor, was used at a mean daily dose of 2.5 mg to immunosuppress 43 patients undergoing high-risk corneal transplantation. Immunosuppression was continued for a period of 18–24 months after the high-risk corneal graft.

Results: During a mean follow-up period of 33.7 months, clarity of the graft was maintained in 65% of patients. Eight patients experienced rejection episodes while on tacrolimus, and this led to graft failure in five patients.

Conclusion: Tacrolimus is relatively safe and effective in reducing rejection and prolonging graft survival in patients with high-risk keratoplasty compared with other series where similar immunosuppression was not used.

  • HLA, human leucocyte antigen
  • HSVK, herpes simplex virus keratitis

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  • Published Online First 6 September 2006

  • Funding: This study was supported by Astellas Pharma, formerly known as Fujisawa Pharmaceuticals, in the form of a stipend paid to AJ during her time as clinical research fellow at the Queen’s Medical Centre, Nottingham.

  • Competing interests: None declared.