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J. Armitage, M. N. A. Jones, S. B. Kaye, Ocular Tissue Advisory Group; Donor and Recipient Factors Influencing Primary Graft Failure. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2314.
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Primary graft failure (PGF) is typically ascribed to donor factors such as poor quality corneas or to technical difficulties at the time of surgery. Our aim was to determine whether any recipient factors were also associated with PGF.
UK Transplant routinely collects follow-up data on 2500 corneal transplants per annum. Data are submitted by surgeons using standard forms at the time of surgery and then at 1, 2 and 5 years postoperatively. If a graft has failed, the reason for failure is recorded, which allows PGF (i.e., graft never cleared) to be identified. All of the corneas were stored by organ culture (34°C). The corneal endothelium was examined by light microscopy 3 days before surgery and only corneas with endothelial cell densities (ECD) >=2200 cells/mm² were issued for penetrating keratoplasty (PK). Binary logistic regression analysis was used to determine donor and recipient factors that influenced the risk of PGF while simultaneously controlling for other factors.
Data were analysed from 10 708 PKs performed between 1999 and 2006. The overall rate of PGF was 0.6%. No donor factors, including age, death to enucleation time, and time in organ culture, were found to influence the risk of PGF except possibly ECD <=2400 cells/mm² (OR 1.9 compared with ECD >2600 cells/mm², 95% CI 0.96-3.8, p=0.07). However, PGF did vary with indication for PK, ranging from 0.2% (6/2523) for ectasias (taken as the baseline in the analysis) to 0.9% (8/896) for infection (OR 3.3, 95% CI 1.1-9.7, p=0.03), 1.0% (3/296) for ulcerative keratitis (OR 3.8, 95% CI 0.94-15.3, p=0.06), 1.1% (16/1487) for regrafts (OR 4.1, 95% CI 1.6-10.5, p=0.004) and 1.3% (2/154) for miscellaneous indications (OR 4.9, 95% CI 0.99-25.0, p=0.05).
The only donor factor that possibly increased risk of PGF was ECD <=2400 cells/mm². Indication for PK had a strong influence on risk of PGF with infection, regrafts, miscellaneous indications and possibly ulcerative keratitis increasing the risk of PGF at least three fold.
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