Pure and Applied Research

Risk Factors for Corneal Graft Rejection after Penetrating Keratoplasty for Keratoconus

Hamad Alsubaie, Ahmad Alrubaian,
Syed Khabir Ahmad, Muhammad Ali Ahad.

Purpose

To evaluate the association between donor-related factors and the risk of rejection in patients undergoing penetrating keratoplasty (PKP) for keratoconus. 

Methods 

A Retrospective review was performed of keratoconus patients with no corneal neovascularization who underwent PKP from November 2014 to December 2016 and completed at least two years of follow-up. Preoperative, donor, operative, and postoperative data were collected and analyzed to identify factors leading to corneal graft rejection.

Results

Among the 201 patients (201 eyes) who underwent PKP, 46 patients (22.9%) had an episode of graft rejection. The graft survival rate was 98.5%. Grafts with a death-to-excision time (DET) greater than 8 hours had a 0.53X lower risk of rejection compared with grafts with DET within 8 hours or less (P = 0.05). Rejection was higher in patients receiving grafts with a preservation time within 7 days or less compared with preservation time greater than 7 days (30.6% vs. 21.2%, respectively, P = 0.291). The rejection rate was higher in patients with a history of corneal transplant in the fellow eye than those without keratoplasty in either eye (32.7% vs. 19.2%, respectively; P = 0.077). Graft rejection was 2.4 times higher if recipients developed postoperative stromal neovascularization (P = 0.003). 

Conclusion

Short DET could be an independent risk factor for rejection after PKP. There were no strong correlations between graft rejection and donor age, donor/recipient gender, or graft size.