title: Transplant rejection following endothelial keratoplasty and penetrating keratoplasty in the United Kingdom: incidence and survival.
abstract: OBJECTIVE
  To investigate the incidence and outcome of cornea transplant rejection following endothelial keratoplasty (EK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK).
  
  
  METHODS
  Multicenter cohort study.
  
  
  METHODS
  Patients registered on the United Kingdom Transplant Registry (UKTR) who had an EK or PK for FED or PBK between April 1, 2005 and March 31, 2011 were included. Data were collected from UKTR forms at 1 and 2 years. Postoperative steroid use varies between surgeons and cannot be captured in this reporting system. Rejection events were identified as those recorded as endothelial rejection.
  
  
  RESULTS
  A total of 3486 corneal transplants were undertaken: 1973 for FED, 1513 for PBK. For FED, 2-year rejection-free survival was 93% (95% confidence interval [CI] 90%-94%) for PK and 94% (95% CI 92%-96%) for EK (P = .3). In transplants that had a rejection episode, 50% of PKs (17) and 60% of EKs (15) subsequently failed. For PBK, 2-year rejection-free survival for PK was 88% (95% CI 86%-90%) and 90% (95% CI 86%-92%) for EK (P = .6). In transplants that had a rejection episode, 85% of PKs (41) and 76% of EKs (22) subsequently failed. Inflammation (ie, conjunctival injection, presence of keratic precipitates and intraocular signs) at the time of surgery for patients with FED was significant for developing rejection: 3.5 times greater compared with those with no inflammation (P = .02).
  
  
  CONCLUSIONS
  There is no significant difference in rejection-free survival between EK and PK for FED or PBK. The presence of inflammation is an important risk factor, and attention to its control before and following surgery is important.
authors.affiliation: Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. Electronic address: gustavofigueiredo@hotmail.com.
authors.forename: Gustavo Souto Maior
authors.initials: GS
authors.lastname: Figueiredo
authors.affiliation: National Health Service Blood and Transplant, Statistics and Clinical Studies, Bristol, United Kingdom.
authors.forename: Mark Neville Arthur
authors.initials: MN
authors.lastname: Jones
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Yamini
authors.initials: Y
authors.lastname: Krishna
authors.affiliation: Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
authors.forename: Francisco Carlos D'Amorim
authors.initials: FC
authors.lastname: Figueiredo
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Daniel Frank P
authors.initials: DF
authors.lastname: Larkin
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Stephen Bruce
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D001768:Blister / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D003316:Corneal Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D004728:Endothelium, Corneal / Q000637:transplantation*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology