Risk factors of corneal graft failure.
OBJECTIVE
To measure the association between potential risk factors and corneal graft failure. Two failure outcomes are compared: those with and those without a prior immune allograft reaction.


METHODS
Based on a single-center observational study design, 539 adult recipients of a corneal graft were followed for a median time of 30 months. Survival analysis was carried out.


RESULTS
Eighty-two graft failures were recorded. Of 82 failures, 53 (65%) were not preceded by an immune allograft reaction. Presence of blood vessels in the recipient cornea was associated with a twofold increase in risk for both failure outcomes. Three factors increased the risk of failure without an immune reaction: prior glaucoma or uveitis (adjusted relative risk estimate = 3.1), vitreous surgery with the graft (adjusted relative risk estimate = 2.0), and a repeat graft in the study eye (adjusted relative risk estimate = 2.0). Conversely, large graft wound size (adjusted relative risk estimate = 2.0). Conversely, large graft wound size (adjusted relative risk estimate = 2.9) and human leukocyte antigen (HLA)-A, -B incompatibility (adjusted relative risk estimate = 2.2) were associated with failures that followed an immune reaction.


CONCLUSIONS
In this study, the authors support the clinical impression that corneal graft failures with and without a prior immune reaction are distinct phenomena. Enhanced surveillance in recipients with glaucoma and early intensive treatment of allograft reactions are recommended to improve the outcome of corneal grafts.
Boisjoly
H M
HM
Ophthalmology Research Unit, Centre Hospitalier de l'Université Laval Research Center, Laval University School of Medicine, Québec City, Canada.
Tourigny
R
R
Bazin
R
R
Laughrea
P A
PA
Dubé
I
I
Chamberland
G
G
Bernier
J
J
Roy
R
R
D002387:Cataract Extraction; D016039:Corneal Transplantation; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014184:Transplantation, Homologous; D014605:Uveitis / Q000150:complications; D014821:Vitrectomy / Q000009:adverse effects