title: Long-term outcomes in patients who received a corneal graft for keratoconus between 1980 and 1986.
abstract: OBJECTIVE
  To estimate the probability of allograft rejection, graft failure, and recurrent keratoconus (KC) and to assess vision-specific quality of life 20 to 25 years after corneal transplantation for KC.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Two hundred nineteen eyes of 184 subjects were identified from the Michigan Corneal Transplantation Patient Registry as receiving corneal transplantation for KC from 1980 through 1986. Current ophthalmic examinations and the 25-item National Eye Institute Visual Function Questionnaire were obtained. Kaplan-Meier analyses were used to estimate the time-related probability of allograft rejection, graft failure, and KC recurrence. Cox regression was used to identify predictive factors of these outcomes. The 25-item National Eye Institute Visual Function Questionnaire scores were summarized with descriptive statistics.
  
  
  RESULTS
  Follow-up was available up to 27 years after surgery (median, 10 years). Rejection occurred in 98 of 219 grafts. Most rejections occurred in the first 2 years (probability, 41%; standard error, 3%). KC recurrence was noted in 6 grafts 9 to 20 years after surgery, with a 20-year probability of 10% (standard error, 4%). Eighteen grafts failed, with a 20-year probability of 12% (standard error, 3%). Larger host trephine size, male donor gender, and nonwhite donor race were associated with increased rejection hazard. Worse astigmatism and nonwhite recipient race were associated with increased failure hazard. Twenty-eight subjects completed the 25-item National Eye Institute Visual Function Questionnaire at an average of 23 years after surgery (range, 18 to 26 years). Their mean composite score was 84.5 (standard deviation, 12.1).
  
  
  CONCLUSIONS
  Allograft rejection is frequent in the 2 years after corneal graft for KC. However, the 20-year probabilities of graft failure and recurrent KC are low. Given the relative youth of KC graft recipients, these statistics should enhance the information they receive.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan 48105, USA.
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Niziol
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Leah M
authors.initials: LM
authors.lastname: Marcotte
authors.forename: Alan
authors.initials: A
authors.lastname: Sugar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014785:Vision, Ocular / Q000502:physiology; D055815:Young Adult