title: Risk factors for eye bank preparation failure of Descemet membrane endothelial keratoplasty tissue.
abstract: OBJECTIVE
  To assess the results of a single eye bank preparing a high volume of Descemet membrane endothelial keratoplasty (DMEK) tissues using multiple technicians to provide an overview of the experience and to identify possible risk factors for DMEK preparation failure.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  setting: Lions VisionGift and Wilmer Eye Institute at Johns Hopkins Hospital.
  
  
  METHODS
  All 563 corneal tissues processed by technicians at Lions VisionGift for DMEK between October 2011 and May 2014 inclusive.
  
  
  METHODS
  Tissues were divided into 2 groups: DMEK preparation success and DMEK preparation failure.
  
  
  METHODS
  We compared donor characteristics, including past medical history.
  
  
  RESULTS
  The overall tissue preparation failure rate was 5.2%. Univariate analysis showed diabetes mellitus (P = .000028) and its duration (P = .023), hypertension (P = .021), and hyperlipidemia or obesity (P = .0004) were more common in the failure group. Multivariate analysis showed diabetes mellitus (P = .0001) and hyperlipidemia or obesity (P = .0142) were more common in the failure group. Elimination of tissues from donors either with diabetes or with hyperlipidemia or obesity reduced the failure rate from 5.2% to 2.2%. Trends toward lower failure rates occurring with increased technician experience also were found.
  
  
  CONCLUSIONS
  Our work showed that tissues from donors with diabetes mellitus (especially with longer disease duration) and hyperlipidemia or obesity were associated with higher failure rates in DMEK preparation. Elimination of tissues from donors either with diabetes mellitus or with hyperlipidemia or obesity reduced the failure rate. In addition, our data may provide useful initial guidelines and benchmark values for eye banks seeking to establish and maintain DMEK programs.
authors: Cornea and Anterior Segment Service, Wilmer Eye Institute, Johns Hopkins Medical School, Baltimore, Maryland.
authors: Lucas M M
authors: LM
authors: Vianna
authors: Lions VisionGift, Portland, Oregon.
authors: Christopher G
authors: CG
authors: Stoeger
authors: Lions VisionGift, Portland, Oregon.
authors: Joshua D
authors: JD
authors: Galloway
authors: Lions VisionGift, Portland, Oregon; Corneal Services, Devers Eye Institute, Portland, Oregon.
authors: Mark
authors: M
authors: Terry
authors: Oncology Center-Biostatistics/Bioinformatics, Johns Hopkins University, Baltimore, Maryland.
authors: Leslie
authors: L
authors: Cope
authors: Department of Ophthalmology, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil.
authors: Rubens
authors: R
authors: Belfort
authors: Cornea and Anterior Segment Service, Wilmer Eye Institute, Johns Hopkins Medical School, Baltimore, Maryland. Electronic address: aljun@jhmi.edu.
authors: Albert S
authors: AS
authors: Jun
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003886:Descemet Membrane / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000706:statistics & numerical data; D048909:Diabetes Complications; D046148:Donor Selection; D004728:Endothelium, Corneal / Q000473:pathology*; D005125:Eye Banks / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013048:Specimen Handling / Q000592:standards / Q000706:statistics & numerical data*; D014019:Tissue Donors; D017211:Treatment Failure
references: Cornea. 2014 Jun;33(6):644-8
references: 24675376
references: Cornea. 2014 Mar;33(3):319-25
references: 24452215
references: Cornea. 2014 Jul;33(7):683-5
references: 24831199
references: Curr Eye Res. 2014 Sep;39(9):894-901
references: 24588207
references: Cornea. 2014 Nov;33(11):1129-33
references: 25222000
references: Surv Ophthalmol. 1991 Jul-Aug;36(1):1-22
references: 1925941
references: Biochem Biophys Res Commun. 1995 Sep 25;214(3):793-7
references: 7575546
references: Cornea. 2006 Sep;25(8):987-90
references: 17102683
references: Am J Ophthalmol. 2008 Feb;145(2):222-227
references: 18061137
references: Exp Diabetes Res. 2008;2008:818341
references: 18779868
references: Cornea. 2009 Jun;28(5):485-8
references: 19421053
references: Curr Opin Ophthalmol. 2009 Jul;20(4):299-307
references: 19417653
references: Ophthalmology. 2009 Dec;116(12):2361-8
references: 19875170
references: Cornea. 2009 Oct;28(9):966-70
references: 19724219
references: Cornea. 2011 Dec;30(12):1382-6
references: 21993468
references: Ophthalmology. 2011 Dec;118(12):2368-73
references: 21872938
references: Cornea. 2012 May;31(5):469-71
references: 22367047
references: Am J Ophthalmol. 2012 Jun;153(6):1082-90.e2
references: 22397955
references: PLoS One. 2012;7(11):e48388
references: 23139780
references: Curr Opin Lipidol. 2013 Feb;24(1):4-11
references: 23298958
references: Cell Tissue Bank. 2013 Jun;14(2):325-31
references: 22790559
references: Ophthalmology. 2013 Sep;120(9):1769-77
references: 23870299
references: Curr Opin Ophthalmol. 2014 Jul;25(4):319-24
references: 24837574