title: Long-term rejection incidence and reversibility after penetrating and lamellar keratoplasty.
abstract: OBJECTIVE
  To identify risk factors for corneal graft rejection and rejection irreversibility.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  setting: Institutional. patients: A total of 1438 consecutive eyes of 1438 patients who underwent corneal transplantation for optical indication at the Centre Hospitalier National d'Ophtalmologie des XV-XX, Paris, France, between December 1992 and December 2010 were studied. Surgical technique was penetrating keratoplasty (PK) in 1209 cases, anterior lamellar keratoplasty (ALK) in 165 cases, and Descemet stripping with endothelial keratoplasty in 64 cases. main outcome measures: Cumulative incidence of rejection episodes and rejection irreversibility rate.
  
  
  RESULTS
  A total of 299 cases of rejection episodes were identified, of which 145 (48.5%) were irreversible after treatment. In multivariate analysis, the cumulative incidence of rejection episodes was influenced by recipient age (P = .00002), recipient rejection risk (P = .0003), lens status (P = .00003), and surgical group (P = .035). A higher incidence of rejection episodes was observed in young patients (<20 years) and patients aged from 41 to 50, high-risk recipients, aphakic eyes and eyes with anterior chamber intraocular lens, and eyes with PK (compared with eyes with ALK). Rejection episodes were more likely to be irreversible for high-risk recipients (P = .02), for eyes with preoperative hypertony (P = .009), and for eyes with poor visual acuity at presentation (P = .002).
  
  
  CONCLUSIONS
  Recipient rejection risk and surgical group are the main risk factors for rejection as they both influence the incidence of rejection and the reversibility rate. Recipient age and lens status are predictive factors for the occurrence of rejection. Preoperative hypertony is a predictive factor for rejection irreversibility.
authors.affiliation: Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des XV-XX, UPMC Univ Paris 06, Paris, France. emmanuel.guilbert@free.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guilbert
authors.forename: Julien
authors.initials: J
authors.lastname: Bullet
authors.forename: Otman
authors.initials: O
authors.lastname: Sandali
authors.forename: Elena
authors.initials: E
authors.lastname: Basli
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Borderie
mesh_terms: D000328:Adult; D015331:Cohort Studies; D055954:Corneal Endothelial Cell Loss / Q000503:physiopathology; D016039:Corneal Transplantation; D057111:Descemet Stripping Endothelial Keratoplasty; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids