Risk factors for endothelial cell loss after corneal transplantation

Abstract

AbstractPurpose To analyze risk factors for endothelial cell loss after corneal transplantation.Methods Cohort study including 1438 consecutive eyes of 1438 patients who underwent Penetrating Keratoplasty, Anterior Lamellar Keratoplasty, or Descemet Stripping with Endothelial Keratoplasty between 1992 and 2010. To describe post‐operative endothelial cell loss, the biphasic linear model was fitted to grafts with at least 2 (early phase) or 3 (late phase) endothelial cell density (ECD) measurements in time: ECD = ECD0 – (t * E), for t < 1 year (early phase); ECD = A – (t * L), for t > 1 year (late phase). The least squares estimates were used to calculate the coefficients of the various equations for each eye.Results The average follow‐up time was 45.9+39.3 months (mean+SD). The early‐phase and late‐phase annual endothelial cell loss (ECL) were, respectively, ‐24.7+18.8% (n=921) and ‐10.8+10.3% (n=664). Overall, the model‐predicted cell loss was lower than the observed cell loss in the early phase and higher in the late phase. In multivariate analysis, 5 variables significantly influenced the early‐phase endothelial cell loss: graft storage time, recipient rejection risk, preoperative hypertony, surgical group, and rejection episodes. Three variables significantly influenced the late‐phase endothelial cell loss: recipient rejection risk, surgical group, and rejection episodes.Conclusion Extending the graft organ culture time beyond 3 weeks results in higher early cell loss. High‐risk recipient and rejection episodes are important risk factors for cell loss. ALK induces minimal cell loss whereas keratoplasty in eyes with impaired recipient endothelium is associated with high cell loss.