INNOVATION IN COMPOSITE TISSUE TRANSPLANTATION

K.A. Williams, T. Kelly, M. Lowe, D.J. Coster
Ophthalmology, Flinders University, Bedford Park/AUSTRALIA

Body: Introduction. Irreversible corneal graft rejection is a common cause of human corneal transplant failure. In any cohort of patients with penetrating corneal grafts, a proportion may have bilateralgrafts. We investigated whether a rejection episode in one graft was associated with rejection in the other graft, in recipients with bilateral corneal transplants.
Methods. In a prospectively-maintained, national register of 14,865 followed full-thickness corneal grafts, 1,476 patients with bilateral penetrating corneal grafts were identified. Logisticregression was used to calculate the adjusted odds ratio for rejection in one eye following rejection in the other eye. Kaplan-Meier plots were used to determine rejection-free survival times, andCox proportional hazards regression was used for multivariate graft survival analysis.
Results. The occurrence of one or more rejection episodes in the graft in either eye was a significant risk factor (p<0.0001) for graft failure in univariate and multivariate analysis. In thesubset of 1,118 patients with bilateral grafts but no history of previous grafts or rejections in either eye, the adjusted odds ratio for a rejection episode in the first eye following rejection inthe second was 3.27 (95% CI 1.85, 5.79; p<0.001). The adjusted odds ratio was 2.04 (95% CI 1.07, 3.91; p=0.03) for rejection in the second eye following rejection in the first. Significantcovariates were corneal neovascularization and keratoconus as the indication for graft. Grafts with previous rejections in the opposite eye had significantly worse rejection-free survival than graftswith no previous rejections, but better rejection-free survival than grafts with previous rejections in the same eye (p<0.0001). The median time between the first rejection episode in one eye andthe first rejection episode in the other eye was 15 months.
Conclusion. Patients with bilateral corneal grafts who suffer a graft rejection episode in one eye are at significantly greater odds of suffering a rejection episode in the other corneal transplant.They should be counselled appropriately, and care should be exercised in offering a corneal graft in a second eye to high-risk recipients with a stable, functioning graft in the first eye.

Disclosure: All authors have declared no conflicts of interest.