Infectious disease risk factors of corneal graft donors.
OBJECTIVE
To determine how donor health status affects the risk of infection after corneal transplant.


METHODS
An adverse reaction surveillance registry was used to conduct a matched case-control study among transplanted donor corneas from January 1, 1994, to December 31, 2003. Cases comprised 162 reports of endophthalmitis after penetrating keratoplasty including 121 with microbial recovery, of which 59 had concordant donor and recipient microbial isolates. Two controls were matched to each case by surgery date. Conditional logistic regression estimated adjusted odds ratios with 95% confidence intervals according to the premortem status of decedent donors.


RESULTS
Postkeratoplasty endophthalmitis was associated with recent hospitalization (odds ratio, 2.84; 95% confidence interval, 1.61-4.98) and fatal cancer (odds ratio, 2.46; 95% confidence interval, 1.53-3.97) among donors. Endophthalmitis appeared more likely with tissues transplanted longer than 5 days after donation (odds ratio, 1.55; 95% confidence interval, 1.02-2.35). The prevalence of concordant microbial isolates from donors and recipients was greater among fungal endophthalmitis than among bacterial endophthalmitis (P < .001).


CONCLUSIONS
Corneal grafts with eye tissue obtained from donors dying in the hospital or with cancer may have an increased risk of postsurgical endophthalmitis, possibly due to donor-to-host microbial transmission. Together with donor screening and processing, improvements in microbiological control may reduce infection associated with corneal transplant.
Hassan
Sohela S
SS
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, 6565 Fannin St, NC-205, Houston, TX 77030, USA.
Wilhelmus
Kirk R
KR
Dahl
Patricia
P
Davis
Gregory C
GC
Roberts
Russell T
RT
Ross
Kevin W
KW
Varnum
Bruce H
BH
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D016001:Confidence Intervals; D003315:Cornea; D018562:Disease Transmission, Infectious; D009877:Endophthalmitis / Q000382:microbiology / Q000635:transmission*; D005125:Eye Banks / Q000706:statistics & numerical data; D015817:Eye Infections / Q000382:microbiology / Q000635:transmission*; D006304:Health Status; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011183:Postoperative Complications; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D014019:Tissue Donors; D014481:United States