title: Risk factors for human corneal graft failure within the Australian corneal graft registry.
abstract: BACKGROUND
  Our aims were to examine graft survival and visual outcome after full-thickness corneal transplantation.
  
  
  METHODS
  Records of 18,686 penetrating corneal grafts, 14,622 with archival follow-up from 1 to 22 years, were examined within a national database. Kaplan-Meier survival analysis indicated variables of interest for Cox proportional hazards regression analysis. A model clustered by patient to control intereye or intergraft dependence was constructed to identify variables best predicting penetrating corneal graft failure. Visual acuity in the grafted eye was measured by Snellen acuity.
  
  
  RESULTS
  Probability of corneal graft survival was 0.87, 0.73, 0.60, and 0.46 at 1, 5, 10, and 15 years, respectively. Reasons for graft failure included irreversible rejection (34%), corneal endothelial cell failure including cases of glaucoma (24%), and infection (14%). Variables predicting graft failure in multivariate analysis included transplant center, location and volume of surgeon's case-load, graft era, indication for graft, number of previous ipsilateral grafts, lens status, corneal neovascularization at transplantation, a history of ocular inflammation or raised intraocular pressure, graft diameter, and postoperative events including graft neovascularization and rejection. Best-corrected Snellen acuity of 6/12 or better was achieved by 45%, and of less than 6/60 by 26%, of grafted eyes at last follow-up.
  
  
  CONCLUSIONS
  The short-term survival of penetrating corneal transplants is excellent, but the eventual attrition rate appears inexorable and many factors that influence graft survival significantly are not amenable to change. Most penetrating grafts are performed for visual improvement, and excellent acuity will be achieved by approximately half of all grafts.
authors.affiliation: Department of Ophthalmology, Flinders University of South Australia, Adelaide, South Australia, Australia. keryn.williams@flinders.edu.au
authors.forename: Keryn A
authors.initials: KA
authors.lastname: Williams
authors.forename: Marie
authors.initials: M
authors.lastname: Lowe
authors.forename: Christine
authors.initials: C
authors.lastname: Bartlett
authors.forename: Thu-Lan
authors.initials: TL
authors.lastname: Kelly
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Coster
mesh_terms: D017677:Age Distribution; D001315:Australia; D016039:Corneal Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D016208:Databases, Factual; D005128:Eye Diseases / Q000145:classification / Q000209:etiology; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity