title: Clinical presentation, risk factors and treatment outcomes of first allograft rejection after penetrating keratoplasty in early and late postoperative period.
abstract: OBJECTIVE
  Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty.
  
  
  METHODS
  A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information.
  
  
  RESULTS
  A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors).
  
  
  CONCLUSIONS
  Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally.
authors.affiliation: Monash University, Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Perera
authors.forename: V
authors.initials: V
authors.lastname: Jhanji
authors.forename: E
authors.initials: E
authors.lastname: Lamoureux
authors.forename: G
authors.initials: G
authors.lastname: Pollock
authors.forename: I
authors.initials: I
authors.lastname: Favilla
authors.forename: R B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D002452:Cell Count; D003315:Cornea / Q000473:pathology*; D003316:Corneal Diseases / Q000601:surgery; D015925:Cryopreservation; D004728:Endothelium, Corneal / Q000166:cytology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents