title: Effect of donor and recipient factors on corneal graft rejection.
abstract: OBJECTIVE
  To assess the relationship between donor and recipient factors and corneal allograft rejection in eyes that underwent penetrating keratoplasty in the Cornea Donor Study.
  
  
  METHODS
  Overall, 1090 subjects undergoing corneal transplantation for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 5 years. Associations of baseline recipient and donor factors with the occurrence of a probable or definite rejection event were assessed in univariate and multivariate proportional hazards models.
  
  
  RESULTS
  Eyes with pseudophakic or aphakic corneal edema (n = 369) were more likely to experience a rejection event than eyes with Fuchs dystrophy (n = 676) [34% ± 6% vs. 22% ± 4%; hazard ratio = 1.56; 95% confidence interval (CI), 1.21-2.03]. Among eyes with Fuchs dystrophy, a higher probability of a rejection event was observed in phakic posttransplant eyes compared with those that underwent cataract extraction with or without intraocular lens implantation during penetrating keratoplasty (29% vs. 19%; hazard ratio = 0.54; 95% CI, 0.36-0.82). Female recipients had a higher probability of a rejection event than male recipients (29% vs. 21%; hazard ratio = 1.42; 95% CI, 1.08-1.87) after controlling for the effect of preoperative diagnosis and lens status. Donor age and donor recipient ABO compatibility were not associated with rejection.
  
  
  CONCLUSIONS
  There was a substantially higher graft rejection rate in eyes with pseudophakic or aphakic corneal edema compared to that in eyes with Fuchs dystrophy. Female recipients were more likely to have a rejection event than male recipients. Graft rejection was not associated with donor age.
authors.affiliation: Emory Eye Center, Emory University, Atlanta, GA, USA. cds@jaeb.org
authors.forename: R Doyle
authors.initials: RD
authors.lastname: Stulting
authors.forename: Alan
authors.initials: A
authors.lastname: Sugar
authors.forename: Roy
authors.initials: R
authors.lastname: Beck
authors.forename: Michael
authors.initials: M
authors.lastname: Belin
authors.forename: Mariya
authors.initials: M
authors.lastname: Dontchev
authors.forename: Robert S
authors.initials: RS
authors.lastname: Feder
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gal
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mannis
authors.forename: Francis
authors.initials: F
authors.lastname: Price
authors.forename: Walter
authors.initials: W
authors.lastname: Stark
authors.forename: David D
authors.initials: DD
authors.lastname: Verdier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001036:Aphakia, Postcataract / Q000150:complications; D002648:Child; D015715:Corneal Edema / Q000209:etiology / Q000601:surgery; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000209:etiology / Q000601:surgery; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D019591:Pseudophakia / Q000150:complications; D012307:Risk Factors; D014019:Tissue Donors; D014180:Transplantation; D014184:Transplantation, Homologous; D055815:Young Adult