RISK-FACTORS OF CORNEAL GRAFT FAILURE

Purpose. To measure the association between potential risk factors and corneal graft failure. Two failure outcomes are compared: those with and those without a prior immune allograft reaction. Methods. Based on a single-center observational study design, 539 adult recipients of a corneal graft were followed for a median time of 30 months. Survival analysis was carried out. Results: Eighty-two graft failures were reco rded. Of 82 failures, 53 (65%) were not preceded by an immune allograf t reaction. Presence of blood vessels in the recipient cornea was asso ciated with a twofold increase in risk for both failure outcomes. Thre e factors increased the risk of failure without an immune reaction: pr ior glaucoma or uveitis (adjusted relative risk estimate = 3.1), vitre ous surgery with the graft (adjusted relative risk estimate = 2.0), an d a repeat graft in the study eye (adjusted relative risk estimate = 2 .0). Conversely, large graft wound size (adjusted relative risk estima te = 2.9) and human leukocyte antigen (HLA)-A, -B incompatibility (adj usted relative risk estimate = 2.2) were associated with failures that followed an immune reaction. Conclusion: In this study, the authors s upport the clinical impression that corneal graft failures with and wi thout a prior immune reaction are distinct phenomena. Enhanced surveil lance in recipients with glaucoma and early intensive treatment of all ograft reactions are recommended to improve the outcome of corneal gra fts.