The effect of donor age on penetrating keratoplasty for endothelial disease: graft survival after 10 years in the Cornea Donor Study.
OBJECTIVE
To determine whether the 10-year success rate of penetrating keratoplasty for corneal endothelial disorders is associated with donor age.


METHODS
Multicenter, prospective, double-masked clinical trial.


METHODS
A total of 1090 participants undergoing penetrating keratoplasty at 80 sites for Fuchs' dystrophy (62%), pseudophakic/aphakic corneal edema (34%), or another corneal endothelial disorder (4%) and followed for up to 12 years.


METHODS
Forty-three eye banks provided corneas from donors aged 12 to 75 years, using a randomized approach to assign donor corneas to study participants without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines.


METHODS
Graft failure defined as a regraft or, in the absence of a regraft, a cloudy cornea that was sufficiently opaque to compromise vision for 3 consecutive months.


RESULTS
In the primary analysis, the 10-year success rate was 77% for 707 corneas from donors aged 12 to 65 years compared with 71% for 383 donors aged 66 to 75 years (difference, +6%; 95% confidence interval, -1 to +12; P = 0.11). When analyzed as a continuous variable, higher donor age was associated with lower graft success beyond the first 5 years (P<0.001). Exploring this association further, we observed that the 10-year success rate was relatively constant for donors aged 34 to 71 years (75%). The success rate was higher for 80 donors aged 12 to 33 years (96%) and lower for 130 donors aged 72 to 75 years (62%). The relative decrease in the success rate with donor ages 72 to 75 years was not observed until after year 6.


CONCLUSIONS
Although the primary analysis did not show a significant difference in 10-year success rates comparing donor ages 12 to 65 years and 66 to 75 years, there was evidence of a donor age effect at the extremes of the age range. Because we observed a fairly constant 10-year success rate for donors aged 34 to 71 years, which account for approximately 75% of corneas in the United States available for transplant, the Cornea Donor Study results indicate that donor age is not an important factor in most penetrating keratoplasties for endothelial disease.
University of California Davis, Sacramento, California. Electronic address: cds@jaeb.org.
Mark J
MJ
Mannis
Cincinnati Eye Institute, Department of Ophthalmology and Visual Sciences, Cincinnati, Ohio.
Edward J
EJ
Holland
Jaeb Center for Health Research, Tampa, Florida.
Robin L
RL
Gal
Jaeb Center for Health Research, Tampa, Florida.
Mariya
M
Dontchev
Jaeb Center for Health Research, Tampa, Florida.
Craig
C
Kollman
Jaeb Center for Health Research, Tampa, Florida.
Dan
D
Raghinaru
Michigan Cornea Consultants, P.C., Southfield, Michigan.
Steven P
SP
Dunn
Cornea Consultants of Albany, Albany, New York.
Robert L
RL
Schultze
Verdier Eye Center, Grand Rapids, Michigan.
David D
DD
Verdier
Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
Jonathan H
JH
Lass
Ophthalmic Partners of Pennsylvania, Bala Cynwyd, Pennsylvania.
Irving M
IM
Raber
University of Illinois at Chicago, Chicago, Illinois.
Joel
J
Sugar
Gorovoy Eye Specialists, Ft. Meyers, Florida.
Mark S
MS
Gorovoy
W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
Alan
A
Sugar
Emory University (now at Woolfson Eye Institute), Atlanta, Georgia.
R Doyle
RD
Stulting
SightLife, Seattle, Washington.
Monty M
MM
Montoya
San Diego Eye Bank, San Diego, California.
Jeffrey G
JG
Penta
Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
Beth Ann
BA
Benetz
Jaeb Center for Health Research, Tampa, Florida.
Roy W
RW
Beck
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D002648:Child; D015715:Corneal Edema / Q000503:physiopathology / Q000601:surgery; D004311:Double-Blind Method; D005125:Eye Banks; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D014019:Tissue Donors; D055815:Young Adult