title: Repeat penetrating corneal transplantation in patients with keratoconus.
abstract: OBJECTIVE
  To determine factors influencing penetrating corneal graft survival in patients receiving repeat grafts in the same eye after a failed first graft for keratoconus.
  
  
  METHODS
  Large cohort study from a national register of corneal grafts, in which data were recorded prospectively and analyzed retrospectively. Follow-up extended to 23 years.
  
  
  METHODS
  Follow-up was available for 229 regrafts performed in 177 eyes of 173 patients. Regrafts were performed more than once in 16 eyes.
  
  
  METHODS
  Corneal graft survival was analyzed using Kaplan-Meier survival plots and Cox proportional hazards regression, clustered by patient.
  
  
  METHODS
  Graft survival.
  
  
  RESULTS
  Graft survival was significantly worse (P<0.001) for second (n = 176) and third or greater grafts (n = 20), compared with first grafts for keratoconus (n = 4871). Kaplan-Meier survivals at 1, 5, and 15 years postgrafting were 88%, 69%, and 46% for second grafts, and 65%, 49%, and 33% for third and subsequent grafts, respectively (P<0.001). Risk factors associated with graft failure of repeat grafts in multivariate analysis were the geographic location of surgery ("center"; P = 0.04), failure of the previous graft within 10 years of surgery (P = 0.02), recipient age at graft ≥60 years (P = 0.04), occurrence of rejection episodes (P = 0.007), and corneal neovascularization postoperatively (P = 0.007).
  
  
  CONCLUSIONS
  Repeat corneal grafts in eyes originally grafted for keratoconus showed better survival when the previous graft had survived ≥10 years, surgery was performed at a favorable location, the recipient was <60 years old at grafting, and graft rejection and neovascularization were circumvented.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any of the materials discussed in this article.
authors: Department of Ophthalmology, Flinders University, Adelaide, Australia.
authors: Thu-Lan
authors: TL
authors: Kelly
authors: Douglas J
authors: DJ
authors: Coster
authors: Keryn A
authors: KA
authors: Williams
mesh_terms: D015331:Cohort Studies; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000503:physiopathology / Q000601:surgery; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors