The effect of ABO blood incompatibility on corneal transplant failure in conditions with low-risk of graft rejection.
OBJECTIVE
To determine whether corneal graft survival over a 5-year follow-up period was affected by ABO blood type compatibility in participants in the Cornea Donor Study undergoing corneal transplantation principally for Fuchs dystrophy or pseudophakic corneal edema, conditions at low-risk for graft rejection.


METHODS
Multi-center prospective, double-masked, clinical trial.


METHODS
ABO blood group compatibility was determined for 1,002 donors and recipients. During a 5-year follow-up period, episodes of graft rejection were documented, and graft failures were classified as to whether or not they were attributable to immunologic rejection. Endothelial cell density was determined by a central reading center for a subset of subjects.


RESULTS
ABO donor-recipient incompatibility was not associated with graft failure attributable to any cause including graft failure because of rejection, or with the occurrence of a rejection episode. The 5-year cumulative incidence of graft failure attributable to rejection was 32 (6%) for recipients with ABO recipient-donor compatibility and 12 (4%) for those with ABO incompatibility (hazard ratio, 0.65; 95% confidence interval, 0.33 to 1.25; P = .20). The 5-year incidence for a definite rejection episode, irrespective of whether graft failure ultimately occurred, was 64 (12%) for ABO compatible compared with 25 (8%) for ABO incompatible cases (P = .09). Among clear grafts at 5 years, percent loss of endothelial cells was similar in ABO compatible and incompatible cases.


CONCLUSIONS
In patients undergoing penetrating keratoplasty for Fuchs dystrophy or pseudophakic corneal edema, ABO matching is not indicated since ABO incompatibility does not increase the risk of transplant failure attributable to graft rejection.
Dunn
Steven P
SP
Michigan Cornea Consultants, PC, Southfield, USA. cds@jaeb.org
Stark
Walter J
WJ
Stulting
R Doyle
RD
Lass
Jonathan H
JH
Sugar
Alan
A
Pavilack
Mark A
MA
Smith
Patricia W
PW
Tanner
Jean Paul
JP
Dontchev
Mariya
M
Gal
Robin L
RL
Beck
Roy W
RW
Kollman
Craig
C
Mannis
Mark J
MJ
Holland
Edward J
EJ
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility / Q000276:immunology*; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery; D004728:Endothelium, Corneal; D005260:Female; D006084:Graft Rejection / Q000097:blood*; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012204:Rh-Hr Blood-Group System / Q000276:immunology
D000017:ABO Blood-Group System; D012204:Rh-Hr Blood-Group System