title: Factors influencing outcomes of the treatment of allograft corneal rejection.
abstract: OBJECTIVE
  To identify patient characteristics influencing treatment outcomes of allograft corneal rejection.
  
  
  METHODS
  Retrospective case file review.
  
  
  METHODS
  Files containing details of first episode of corneal allograft rejections in patients who underwent penetrating keratoplasty at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia from 1991 to 2006 were reviewed. Cases were divided into 2 groups based on the response to treatment for graft rejection: treatment responders and failures. Main parameters evaluated were demographic characteristics, preoperative clinical profile, donor characteristics, surgical technique, presentation, and treatment of rejection episode.
  
  
  RESULTS
  A total of 235 cases of graft rejection were identified, of which 195 cases (83%) were successfully treated and 40 (17%) failed to respond. Age (P = .08) and gender (P = .61) were comparable in both groups. On univariate analysis, primary diagnosis of keratoconus (P = .04) and phakic lens status at the time of surgery (P = .02) were more common in treatment responders whereas aphakic bullous keratopathy (P ≤ .01), history of glaucoma (P < .01), aphakia (P < .01), and previous grafts (P < .01) were more common among treatment failures. Multivariate analysis revealed that preoperative corneal neovascularization (adjusted odds ratio [aOR] 3.6, 95% CI: 1.3-9.7, P = .01), a larger (>9 mm) donor size (aOR 5.7, 95% CI: 1.3-24.9, P = .02), and corneal edema at presentation (aOR 4.7, 95% CI: 1.7-13.2, P < .01), were independently associated with failure of treatment of graft rejection.
  
  
  CONCLUSIONS
  Treatment failure in cases of corneal allograft rejection is more likely to occur among patients with corneal neovascularization, large donor graft buttons, and corneal edema at presentation.
authors.affiliation: Monash University, Melbourne, Australia.
authors.forename: Chandrashan
authors.initials: C
authors.lastname: Perera
authors.affiliation: The Chinese University of Hong Kong, Hong Kong; Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia.
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia; Royal Victorian Eye and Ear Hospital, Melbourne, Australia. Electronic address: rasikv@unimelb.edu.au.
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D000368:Aged; D003316:Corneal Diseases / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome