Korean J Ophthalmol.  2020 Feb;34(1):35-45. 10.3341/kjo.2019.0086.

Effect of Donor Age on Graft Survival in Primary Penetrating Keratoplasty with Imported Donor Corneas

• Kwon HY
• Hyon JY
• Jeon HS

• KMID: 2469285
• DOI: http://doi.org/10.3341/kjo.2019.0086

Abstract

PURPOSE
To investigate the influence of donor age on corneal graft survival following primary penetrating keratoplasty (PK) with imported donor corneas.
METHODS
The eyes of patients who underwent primary PK with imported donor corneas were classified retrospectively into two groups according to a donor-age cutoff of 65 years. Primary outcome measures were rejection-free graft survival and graft survival. Cox proportional hazard regression analysis was used to assess the factors affecting graft survival. Survival analysis was performed using the Kaplan-Meier method, while differences between groups were examined using a log-rank test. A subgroup analysis of low- and high-risk eyes according to preoperative diagnosis was also performed.
RESULTS
A total of 140 eyes from 138 patients (age, 58 ± 18 years) were enrolled. Cox regression analysis revealed that the donor age of 65 years or older group presented an increased risk of both graft rejection and failure. Survival analysis revealed that rejection-free graft survival and graft survival rates were higher in eyes in the donor age of less than 65 years group. Finally, in the subgroup analysis, both rejection-free graft survival and graft survival rates were significantly higher in the donor age of less than 65 years group than in the donor age of 65 years or older group, but only in the low-risk subgroup.
CONCLUSIONS
Donor age may correlate with graft survival in primary PK performed with imported donor corneas. Donor age could be a considerable factor in primary PK with imported donor corneas, especially in preoperatively low-risk patients.

Keyword

Corneal transplantation; Graft survival; Penetrating keratoplasty; Risk factors

MeSH Terms

Cornea*
Corneal Transplantation
Diagnosis
Graft Rejection
Graft Survival*
Humans
Keratoplasty, Penetrating*
Methods
Outcome Assessment (Health Care)
Retrospective Studies
Risk Factors
Tissue Donors*
Transplants*

Figure

• 

  Fig. 1 Comparison of endothelial cell densities (ECDs, cells/mm2) among donor corneas in four donor age subgroups. Mean ECD tended to decrease with increasing age grade (p = 0.003, Jonckheere-Terpstra test). It was revealed that donors aged <35 years had a significantly higher ECD than donors aged 50–64 or >65 years (*Statistical significance; p = 0.008 and p = 0.016, respectively, Mann%Whitney test).

• 

  Fig. 2 Kaplan-Meier plots of (A) rejection-free graft survival and (B) graft survival in donor age <65 years and donor age ≥65 years groups (log-rank test; (A) X2 = 5.825, p = 0.016 vs. (B) X2 = 13.058, p < 0.001).

• 

  Fig. 3 Kaplan-Meier plots of rejection-free graft survival and graft survival in the two main donor age groups after division into low- and high-risk groups. In the low-risk group, both (A) rejection-free graft survival and (B) graft survival were significantly higher in the donors age <65 years group than that of ≥65 years group (log-rank test; X2 = 5.916, p = 0.015 vs. X2 = 12.472, p < 0.001, respectively). In the high-risk group, both (C) rejection-free survival and (D) graft survival were not significantly different between the two donor age groups (log-rank test; X2 = 0.104, p = 0.747; X2 = 1.153, p = 0.283, respectively).

• 

  Fig. 4 Kaplan-Meier plots of (A) rejection-free graft survival and (B) graft survival in four data-derived donor age subgroups (log-rank test; X2 = 5.895, p = 0.117; X2 = 14.355, p = 0.002, respectively).

• 

  Fig. 5 Kaplan-Meier plots of rejection-free graft survival and graft survival in four data-derived donor age subgroups after division into low- and high-risk groups. In the low-risk group, it was found that (A) the rejection-free graft survival rate was not found to be significantly different, while the (B) graft survival rate was significantly different among the groups (log-rank test; X2 = 6.131, p = 0.105 vs. X2 = 14.907, p = 0.002, respectively). In the high-risk group, both (C) the rejection-free graft survival rate and (D) graft survival rate were not significantly different among the groups (log-rank test; X2 = 2.957, p = 0.398 vs. X2 = 7.385, p = 0.061, respectively).

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