June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Utility of a model to predict endothelial cell density of donor corneas to determine suitability for transplantation: a decision curve analysis.
Author Affiliations & Notes
  • Stephanie Desiree Grabitz
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Julia Bing Bu
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Franziska Schön
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Melissa Apel
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Tobias Pusch
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Adrian Gericke
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Alicia Poplawski
    Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, Germany
  • Norbert Pfeiffer
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Joanna Wasielica-Poslednik
    Universitatsmedizin der Johannes Gutenberg-Universitat Mainz Augenklinik und Poliklinik, Mainz, Rheinland-Pfalz, Germany
  • Footnotes
    Commercial Relationships   Stephanie Grabitz None; Julia Bing Bu None; Franziska Schön None; Melissa Apel None; Tobias Pusch None; Adrian Gericke None; Alicia Poplawski None; Norbert Pfeiffer None; Joanna Wasielica-Poslednik None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 651. doi:
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      Stephanie Desiree Grabitz, Julia Bing Bu, Franziska Schön, Melissa Apel, Tobias Pusch, Adrian Gericke, Alicia Poplawski, Norbert Pfeiffer, Joanna Wasielica-Poslednik; Utility of a model to predict endothelial cell density of donor corneas to determine suitability for transplantation: a decision curve analysis.. Invest. Ophthalmol. Vis. Sci. 2023;64(8):651.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In Germany, approximately one third of harvested donor corneas are not suitable for transplantation, mostly due to insufficient endothelial cell density (ECD). ECD can only be determined after harvesting and extensive preparation of the cornea. Our group has previously developed a prediction model for the ECD:

Predicted ECD [cells/mm2] = 2919 – 6* age [years] – 189 [if male] – 7* death-to-explantation interval [hours] – 378 [if pseudophakic]

The aim of this study was to evaluate the utility of the proposed prognostic model as a screening instrument for transplant eligibility in an independent cohort.

Methods : A total of 2,999 consecutive donor corneas harvested from the Eye Bank Rheinland-Pfalz in Mainz, Germany, between 2017 and 2021 were included. An actual ECD of >2000 cells/mm2 was defined as the cut-off value for transplantability of donor corneas. To evaluate the clinical utility of the predicted ECD in terms of transplantability, we performed a decision curve analysis.

Results : Of 2,999 donor corneas analyzed, 2,111 (70,4%) were suitable for transplantation. The median predicted ECD was 2061 cells/mm2 (IQR 1834, 2221) and the median actual ECD was 2377 cells/mm2 (IQR 1907, 2624), respectively.
In decision curve analysis the x-axis represents the predicted probability of a transplantable cornea at which the decision to harvest the donor cornea would be made in a specific clinical setting. The Y-axis represents the corresponding net benefit, defined as the proportion of correct positive classifications subtracted from the proportion of false negatives, weighted by the risk threshold. In clinical settings with high reprocessing capacity, a relatively low predicted probability (e.g. 30%) for an ECD >2000 cells/mm2 may be sufficient for harvesting. At this threshold, examination of all corneas (blue line) has the highest net benefit. In clinical situations where a risk threshold of 45% or more is required for a transplantable donor cornea, our prognostic model shows a higher net benefit. Figure 1

Conclusions : Decision curve analysis demonstrated a positive net benefit of the ECD prediction model in clinical settings with limited eye bank resources aiming for a risk threshold of 45% or more for a transplantable donor cornea.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1: Decision curve analysis

Figure 1: Decision curve analysis

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