title: Risk factors for graft failure after penetrating keratoplasty: 5-year follow-up from the corneal transplant epidemiological study.
abstract: OBJECTIVE
  To evaluate corneal graft survival over a 5-year period and to investigate whether factors related to the donor, eye bank practices, the recipient, surgery, and postoperative course influenced the outcome.
  
  
  METHODS
  Nine hundred ninety-eight patients were randomly selected and monitored in the subsequent 3 years from a cohort of 4500 recipients who underwent penetrating keratoplasty between 2001 and 2004. Cox univariate regression analysis was used to select variables to be included in a multivariate Cox proportional hazards model with a backward selection procedure to identify potential risk factors for graft failure. Graft survival curves were obtained from Kaplan-Meier estimates.
  
  
  RESULTS
  Ectasia/thinning was the most common indication (49.1%), followed by regraft (16.1%) and pseudophakic corneal edema (PCE) (9.4%). The overall rate of graft failure was 10.7% with 6 cases of primary graft failure. Adverse reactions and complications (other than graft failure) were reported in 2.7% of patients in the first postoperative week and in 22.8% during the full follow-up period. The probability of 5-year survival was 83.0%, best in eyes with ectasia/thinning (96.0%) and less favorable in PCE (67.0%) and regraft (64.0%). Multivariate analyses showed the following variables to be linked to an increased risk of graft failure: regraft for any reason, all clinical indication except PCE, history of ocular inflammation/infection, pseudophakic/aphakic eye, vitrectomy, graft Descemet folds, adverse reactions/complications, and surgeons' low caseload.
  
  
  CONCLUSIONS
  Penetrating keratoplasty shows an overall positive prognosis in the long-term. However, the probability of graft survival is largely dependent on the preoperative clinical condition and the lack of complications during follow-up.
authors.affiliation: Fondazione Banca degli Occhi del Veneto, Venezia, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Fasolo
authors.forename: Cristina
authors.initials: C
authors.lastname: Capuzzo
authors.forename: Michela
authors.initials: M
authors.lastname: Fornea
authors.forename: Antonella
authors.initials: A
authors.lastname: Franch
authors.forename: Federica
authors.initials: F
authors.lastname: Birattari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carito
authors.forename: Flavio
authors.initials: F
authors.lastname: Cucco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Prosdocimo
authors.forename: Michele
authors.initials: M
authors.lastname: Sala
authors.forename: Nicola
authors.initials: N
authors.lastname: Delle Noci
authors.forename: Vito
authors.initials: V
authors.lastname: Primavera
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigoletto
authors.forename: Diego
authors.initials: D
authors.lastname: Ponzin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult