title: The influence of Australian eye banking practices on corneal graft survival.
abstract: OBJECTIVE
  To identify eye banking practices that influence corneal graft survival.
  
  
  METHODS
  Prospective cohort study of records of 19,254 followed corneal grafts in 15160 patients, submitted to the Australian Corneal Graft Registry between May 1985 and July 2012.
  
  
  METHODS
  Influence of corneal preservation method (organ culture, moist pot, Optisol, other); death-to-enucleation, death-to-preservation and enucleation-to-graft times; transportation by air; graft era; and indication for graft on probability of graft survival at most recent follow-up.
  
  
  RESULTS
  In multivariate analysis, 919 penetrating grafts performed using corneas transported interstate by air exhibited worse survival than 14,684 grafts performed using corneas retrieved and used locally (hazard ratio [HR], 1.44; 95% CI, 1.21-1.73; P = 0.001). This was also the case for traditional lamellar grafts (64 corneas transported by air and 813 used locally; HR, 1.69; 95% CI, 1.03-2.78; P = 0.038). Indication for graft influenced survival of penetrating grafts (4611 keratoconus, 727 emergency or high-risk, 10,265 other indication; global P < 0.001) and traditional lamellar grafts (65 keratoconus, 212 emergency or high-risk, 600 other indication; global P < 0.001). The preservation medium in which corneas used for traditional lamellar grafts were stored exerted a marginal influence on graft survival (global P = 0.047).
  
  
  CONCLUSIONS
  Donor corneas transported interstate exhibited poorer survival after transplantation than those retrieved and grafted locally. Higher proportions of emergency procedures involving transported corneas did not account for this difference. Where possible, efforts to avoid transportation of corneal tissue by air freight within Australia may be warranted.
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, SA, Australia. miriam.keane@flinders.edu.au
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Keane
authors.forename: Marie T
authors.initials: MT
authors.lastname: Lowe
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Coster
authors.forename: Graeme A
authors.initials: GA
authors.lastname: Pollock
authors.forename: Keryn A
authors.initials: KA
authors.lastname: Williams
mesh_terms: D001315:Australia; D015331:Cohort Studies; D016001:Confidence Intervals; D003316:Corneal Diseases / Q000453:epidemiology / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D005125:Eye Banks / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016017:Odds Ratio; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life; D014021:Tissue Preservation / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous