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Hon Shing Ong, Nathalie Chiam, Hla Myint Htoon, Anshu Arundhati, Jodhbir S Mehta; The Effects of Donor-Recipient Age and Sex Compatibility in the Outcomes of Anterior Lamellar Keratoplasties. Invest. Ophthalmol. Vis. Sci. 2021;62(8):987.
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Corneal transplantations are the commonest allogenic transplant surgeries performed worldwide. Transplantable grade donor cornea is a finite resource. There is thus an impetus for eye banks to optimise the use of each harvested cornea, and clinicians to minimise risks of graft rejection and failure.Studies on donor-recipient (D-R) age or sex compatibility have mainly been focused on penetrating keratoplasty (PK) and endothelial keratoplasty (EK) procedures. Although studies have reported beneficial effects of sex or H-Y matching in lowering risks of PK or EK rejection and failure, current evidence is still equivocal.With better survival and lower rejection rates, anterior lamellar keratoplasty (ALK) has gained popularity as an alternative to PK, to treat corneal stromal diseases. We evaluated the effects of D-R age- and sex-matching on the outcomes of eyes that had undergone ALK surgeries.
ALK surgeries performed in an ophthalmic hospital over an 11-year period were identified (graft registry data). To analyse the effects of sex-matching, transplants were classified as ‘presumed H-Y incompatible’ (male donor to female recipient) or ‘presumed H-Y compatible’ (all other D-R sex combinations). For age-matching, differences in donor and recipient ages were calculated. Cox proportional hazards regressions were used to assess the influence of D-R sex- and age-matching on graft failure and rejection.
359 eyes (322 patients) were included. 246 (68.5%) grafts were presumed H-Y compatible. 14 (3.9%) grafts failed and 8 (2.2%) rejected. There were trends of lower hazard ratios (HRs) in graft failure and rejection in the presumed H-Y compatible group (0.59[95% CI 0.20-1.77] and 0.93[95% CI 0.22-3.89], respectively). Median difference in age between recipients and donors was 14.9 years (IQR 2.8-33.2). HRs of graft failure and rejection were not influenced by D-R age (HRs per 1-year increase in age difference: 1.00[95% CI 0.98-1.02] and 1.01[95% CI 0.99-1.03], respectively).
Sex- or age-matching had no significant effect on ALK rejection and failure. Although trends of fewer graft rejection and failure in presumed H-Y compatible grafts were observed, over 500,000 ALK surgeries would be required to achieve adequate power to show significant effects of matching, if any. Routine sex- and age-matching during graft allocation for ALK surgeries thus cannot be recommended.
This is a 2021 ARVO Annual Meeting abstract.
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