title: Corneal graft rejection 10 years after penetrating keratoplasty in the cornea donor study.
abstract: OBJECTIVE
  The aim of this study was to assess the effect of donor and recipient factors on corneal allograft rejection and evaluate whether a rejection event was associated with graft failure.
  
  
  METHODS
  One thousand ninety subjects undergoing penetrating keratoplasty for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 12 years. Associations of baseline recipient and donor factors with the occurrence of a rejection event were assessed in univariate and multivariate proportional hazards models.
  
  
  RESULTS
  Among 651 eyes with a surviving graft at 5 years, the 10-year graft failure (±99% confidence interval) rates were 12% ± 4% among eyes with no rejection events in the first 5 years, 17% ± 12% in eyes with at least 1 probable, but no definite rejection event, and 22% ± 20% in eyes with at least 1 definite rejection event. The only baseline factor significantly associated with a higher risk of definite graft rejection was a preoperative history of glaucoma, particularly when previous glaucoma surgery had been performed and glaucoma medications were being used at the time of transplant (10-year incidence 35% ± 23% compared with 14% ± 4% in eyes with no history of glaucoma/intraocular pressure treatment, P = 0.008).
  
  
  CONCLUSIONS
  Patients who experienced a definite rejection event frequently developed graft failure raising important questions as to how we might change acute and long-term corneal graft management. Multivariate analysis indicated that previous use of glaucoma medications and glaucoma filtering surgery was a significant risk factor related to a definite rejection event.
authors.affiliation: *Michigan Cornea Consultants and Department of Ophthalmology, Oakland University/William Beaumont School of Medicine, Southfield-Rochester, MI; †Jaeb Center for Health Research, Tampa, FL; ‡Inland Eye Institute, Colton, CA; §Cincinnati Eye Institute and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH; ¶Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH; ‖Eye Health Vision Center, Tufts University School of Medicine, Harvard Medical School, Boston, MA; **University of California Davis, Sacramento, CA; ††WK Kellogg Eye Center, the University of Michigan, Ann Arbor, MI; ‡‡Corneal Associates, PC, Wills Eye Hospital, Philadelphia, PA; and §§The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Dunn
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gal
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: Dan
authors.initials: D
authors.lastname: Raghinaru
authors.forename: Mariya
authors.initials: M
authors.lastname: Dontchev
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Blanton
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lass
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Kenyon
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mannis
authors.forename: Shahzad I
authors.initials: SI
authors.lastname: Mian
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rapuano
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Stark
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
mesh_terms: D000368:Aged; D064591:Allografts; D015715:Corneal Edema / Q000601:surgery; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D014019:Tissue Donors; D066027:Transplant Recipients