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Risk factors for corneal graft rejection after penetrating keratoplasty in keratoconus

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First Author: H.Hamad SAUDI ARABIA

Co Author(s):    M. Ahad                    

Abstract Details

Purpose:

The aim of this study is to evaluate association between donor or recipient related factors and risk of rejection in patients undergoing penetrating keratoplasty for keratoconus.

Setting:

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

Methods:

Retrospective cohort study enrolled 201 keratoconus patients with no corneal neovascularization who underwent their first penetrating keratoplasty at King Khaled Eye Specialist Hospital (KKESH) from November 2014 to December 2016 with at least two years follow up.

Results:

Out of total 201 patients, 46 (22.9%) had episode of graft rejection, however graft survival was 98.5%. The median time of graft rejections episodes was 12 months. 123 (61.2%) of donors were male and 78 (38.8%) were female. A total of 113 (56.2%) of recipients were male and 88 (43.8%) were female. The mean age of donors was 55 years (range 17 -74) and the mean age of recipient was 27 years (range 14- 55). Recipients aged <25 years old have slightly higher risk of graft rejection (26.6%) compared with recipients aged ≥25 years (20.5%) (p = 0.379). Grafts with death exciton time (DET) >8 hours have 0.53 times lower risk of rejection compared with graft ≤8 hours (p = 0.05). Rejection in patients receiving graft with preservation time ≤7 days was (30.6%) compared to patients with preservation time >7 days (21.2%) (p = 0.291). The median graft size in this study was 8.00 mm. Interrupted sutures had 1.37 times more risk of rejection than corneas sutured by continuous technique (p = 0.304).

Conclusions:

Rejection in patients with history of graft in the other eye was (32.7%) compared with patients not grafted in the other eye (19.2%) (p = 0.077). The risk of graft rejection is 2.35 times more if recipients developed stromal neovascularization post-surgery (p = 0.003). This retrospective study showed high rate of graft rejections in low risk keratoconus patients. However, graft survival was as high as 98.5% which necessitate close follow up at least in the first two years. Risk factors of graft rejection included recipient corneal neovascularization, short death excision time (DET), younger recipients and history of corneal graft in the other eye. There is some evidence that risk of rejections is lower if graft is secured with continuous sutures and graft preservation time exceeds one week. This is against current practice which favors grafts with shorter preservation time and shorter DET.

Financial Disclosure:

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