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Impressum
Risk factor analysis for endothelial immune rejection: Intermediate results of a prospective non-high-risk keratoplasty study
Küchle M., Cursiefen C., Langenbucher A., Nguyen N. X., Seitz B., 1Martus P.
Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen- Nürnberg, Schwabachanlage 6, 91054 Erlangen; 1Inst. für Med. Statistik, Biometrie und Epidemiologie, FU Berlin, Berlin
Background: Since 1996, a non-high-risk keratoplasty study analyses
risk factors for episodes of immunologic endothelial transplant rejection
after non-high-risk keratoplasty.
Methods: Up to now (19/1996-5/2001), 397 patients were recruited
in a prospective study and were regularily followed according to our study
protocol. Main diagnoses leading to keratoplasty were keratoconus in 44%,
Fuchs' dystrophy in 27% and bullous keratopathy in 10%. Clinical data
and examinations were stored in an Access database. Time to transplant
rejection was evaluated using the proportional harzard model for censored
data (Cox-model).
Results: Out of the 397 analyzed patients, up to now 19 (4.7%)
developed an episode of endothelial immune rejection, which was irreversible
in only 1 patient (median follow-up: 18 months). There was an equal distribution
of transplant rejections between 12 and 36 months after surgery, but only
1 within the first postoperative year. We observed the following trends:
increased risk for subsequent transplant rejection in the age group between
20 and 40 years, higher with increasing transplant diameter, no increase
in combined operations nor associated with gender. 74% of patients with
transplant rejection had superficial new corneal vessels growing towards
the host-graft-junction prior to immune rejection.
Conclusions: Although the rate of immune rejections in our study
was so far somewhat lower than reported in the literature, regular postoperative
clinical follow-up beyond the early postoperative time period is advocated.
Because of the low rate of transplant rejections, further recruitment
of patients is necessary before a detailed statistical analysis of additional
risk factors including the role of prolonged topical steroids is possible.
Support: BMBF (IZKF Erlangen, B13)