Outcomeofinitial corneal transplant rejection episodes

Abstract

Abstract: : Purpose: To determine the characteristics and response to therapy of initial episodes of graft rejection. Methods: Charts of all patients in the Cornea Service undergoing their first corneal transplant in the first eye between 1998–2002 were reviewed. Patients diagnosed with their first graft rejection and treated with topical steroids were included. Patient demographics, type of rejection, type of treatment and response to therapy were recorded. Multiple logistic regression analysis was used to model the relationship between various predictors and graft failure. Results: Initial corneal graft rejections were noted in 115 patients. The average age was 61.4 years (SD 17.72 years) and 44.35 % were male. Epithelial rejection occurred in 1.7%, sub–epithelial rejection in 20.0% and endothelial rejection in 78.3% of the cases. Complete resolution was seen in 82.9% of endothelial rejection and in 100% of epithelial and sub–epithelial rejections, at mean time 35.2 and 24.1 days, respectively. Failure occurred in 16.5% of the cases overall. In the regression analysis, increased age (odds ratio [OR] = 1.74, p< 0.01) and presence of symptoms (OR= 4.7, p< 0.01) were statistically associated with failure. Number of days with symptoms did not increase the chance of failure (p> 0.05). Conclusions:Topical steroids were effective in treating initial graft rejections, especially epithelial and sub–epithelial rejections. Each decade of life increased the chance of failure by 74%. Individuals with symptoms were 4.7 times more likely to have a failure than those without symptoms.

Keywords: transplantation • clinical (human) or epidemiologic studies: outcomes/complications • corticosteroids