Immunologic graft reactions after allogenic penetrating keratoplasty

• Published in: American journal of ophthalmology 2002-04, Vol.133 (4), p.437-443
• Main Authors: Jonas, Jost B, Rank, Rainer M, Budde, Wido M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Corneal Neovascularization - complications; Female; Glucocorticoids - therapeutic use; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Rejection - immunology; Humans; Keratoplasty, Penetrating - adverse effects; Male; Medical sciences; Middle Aged; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Suture Techniques - adverse effects; Time Factors; Transplantation, Homologous
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(01)01426-X

PURPOSE: To evaluate frequency and risk factors of immunologic graft reactions after allogenic penetrating keratoplasty. DESIGN: Interventional comparative nonrandomized clinical trial. METHODS: The setting took place in a university eye hospital. The retrospective study included 338 patients (338 eyes). The patients underwent penetrating keratoplasty performed by a single surgeon in the study period from 1989 to 1997. Follow-up period had to be longer than 12 months (mean ± SD, 31.4 ± 18.8 months). Frequency of immunologic graft reactions characterized by relatively few small monomorph whitish cells in the anterior chamber, almost no flare, and retrocorneal cellular precipitates. RESULTS: Immunologic graft reactions were detected in 46 patients (46/338 = 13.6%). Statistically significant risk factors for the development of graft reactions were loosening of sutures ( P = .046), and preoperative and postoperative corneal vascularization ( P = .04). Frequency of an immunologic graft reaction was statistically independent ( P > .05) of the graft diameters used in the present study, age, and gender of the patients, HLA-typing, donor age, and preservation data of the donor material. Seventy-four percent (34/46) of all graft reactions were detected within the first 2.5 years after surgery. Thirteen percent (6/46) of all graft reactions were observed more than 4 years after keratoplasty. With intensive corticosteroid treatment, graft transparency could be regained in 44 (95.6%) of the 46 patients with an immunologic graft reaction. CONCLUSIONS: Most important risk factors for immunologic graft reactions occurring in approximately 14% of patients after allogenic penetrating keratoplasty are suture loosening and preoperative and postoperative corneal vascularization. Graft diameters as used in the present study, HLA-typing, age of the donor, and preservation data of the donor material may not play a major role. More than 10% of graft reaction episodes can occur more than 4 years postgrafting. With intensive corticosteroid treatment, graft transparency can be regained in the majority of patients after an immunologic graft reaction when detected early.