Donor Risk Factors for Graft Failure in a 20-Year Study of Penetrating Keratoplasty

Patel, Sanjay V.; Diehl, Nancy N.; Hodge, David O.; Bourne, William M.

doi:10.1001/archophthalmol.2010.27

Cited by 66 publications

(63 citation statements)

References 23 publications

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“…2 Although immune privilege of corneal allografts endows a high success rate of corneal transplant than other solid-organ transplants, immunologic rejection remains a major cause of graft failure after corneal transplant. 3,4 Regulatory CD4 + CD25 + Foxp3 + T cells (Treg), an important regulator in maintaining immune homeostasis, play a crucial role in autoimmune diseases and tumors, and protect individuals from graft rejection. 5 However, Treg cells are present in low numbers under normal conditions, reported to be 5% to 10% of CD4 + T cells in mice and human blood, and have an anergic phenotype.…”

mentioning

confidence: 99%

Pretreatment of Rapamycin Before Allogenic Corneal Transplant Promotes Graft Survival Through Increasing CD4+CD25+Foxp3+ Regulatory T Cells

Wang

Wang²,

Jia³

et al. 2012

Exp Clin Transplant

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Key words: Rapamycin, Regulatory T cells, Corneal transplantCorneal disease, one of the leading causes of blindness in China, 1 requires a corneal transplant to restore visual function in most cases. 2 Although immune privilege of corneal allografts endows a high success rate of corneal transplant than other solid-organ transplants, immunologic rejection remains a major cause of graft failure after corneal transplant. 3,4 Regulatory CD4 + CD25 + Foxp3 + T cells (Treg), an important regulator in maintaining immune homeostasis, play a crucial role in autoimmune diseases and tumors, and protect individuals from graft rejection. 5 However, Treg cells are present in low numbers under normal conditions, reported to be 5% to 10% of CD4 + T cells in mice and human blood, and have an anergic phenotype. 6 Therefore, enhancement of activated Treg cells may protect individuals from autoimmune diseases and graft rejection, just as previous studies have revealed. [7][8][9][10] Rapamycin, a novel macrolide immunosuppressive drug, has been reported to prevent clinical allograft rejections including corneal allografts. 11 Moreover, rapamycin allows expansion of CD4 + CD25 + Foxp3 + Treg in vitro and in vivo, 12-14 and CD4 + CD25 + Foxp3 + Treg converted by rapamycin has more-potent regulatory abilities. 15 It has been shown that adoptive transfer of CD4 + CD25 + Foxp3 + Treg expanded by rapamycin in vitro is capable of artIClE

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mentioning

confidence: 99%

Pretreatment of Rapamycin Before Allogenic Corneal Transplant Promotes Graft Survival Through Increasing CD4+CD25+Foxp3+ Regulatory T Cells

Wang

Wang²,

Jia³

et al. 2012

Exp Clin Transplant

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“…When indicated for optical purposes, PK surgeons prefer transplanting donor cornea tissues with quality ranging from good to very good to excellent to provide adequate endothelial cells for a lifelong period. The acceptable conditions for PK donors are donor age varying from 1 to 96 years [9][10][11][12][13][14][15][16], endothelial cell density between 2000 and ≥ 3000 cells/mm In contrast to penetrating keratoplasty, donors with quality ranging from fair to excellent are employed for DALK [20,21]. Furthermore, long-term preserved donor tissues completely devoid of cells are also transplanted [22][23][24][25].…”

Section: Type and Quality Of Donors Used For Pk And Dalkmentioning

confidence: 99%

“…Despite contradictory results of studies evaluating the effect of donor and eye-bank variables on postoperative ECD and morphology, the majority of studies showed that donor preservation method and time, donor age, cause of death, and preoperative donor ECD and/or morphometric measures (coefficient of variation and hexagonality) had no influence on overall graft failure [12,14,26,[38][39][40][41]. However, one study reported that preoperative risk factors for developing late endothelial failure included low ECD and older donor age [16].…”

Section: Effect Of Donor and Eye-bank Variables On Clinical Outcomesmentioning

confidence: 99%

Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Feizi¹

2016

Advances in Eye Surgery

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Deep anterior lamellar keratoplasty (DALK) has been recently introduced as an alternative to penetrating keratoplasty (PK) for corneal pathologies not involving corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, it provides a greater availability of donor corneas that do not need perfectly healthy endothelium and high endothelial cell density to be suitable for PK. Furthermore, as lamellar corneal surgery expands the potential use of acellular corneal tissue, long-term preservation techniques are being revisited as a way to increase availability of corneal tissue to alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in the technique of corneal transplantation and hence the type of donor cornea tissues used for each technique, may require eye banks and corneal surgeons to reassess their selection criteria but it is important for any changes to be evidence-based. The purpose of this chapter, therefore, is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, to evaluate the impact of donor and eye bank variables on the suitability of corneas for transplantation and then go on to determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.

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“…The McCareyKaufman (MK) preservation medium extended the potential storage time to 5 days (Breslin et al 1976;McCarey et al 1976;Van Horn and Schultz 1975). Intermediate-term hypothermic storage medium that includes chondroitin sulfate storage medium (CSM), Dexsol, K-Sol and Optisol-GS extended storage time further to between 7 and 14 days (Patel et al 2010;Basu 1995;Kaufman et al 1985;Lindstrom et al 1986;Kaufman et al 1991). In contrast, normo-thermic methods with Organ Culture storage provides the advantage of donor storage time of up to 30-40 days (Doughman et al 1976).…”

mentioning

confidence: 99%

Implementation of Organ Culture storage of donor corneas: a 3 year study of its impact on the corneal transplant wait list at the Lions New South Wales Eye Bank

et al. 2016

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Organ Culture corneal storage offers an extended storage time and increased donor pool and tissue assessment opportunities. In September 2011, the Lions New South Wales Eye Bank (LNSWEB) moved from hypothermic storage to Organ Culture corneal storage. This study evaluates the impact of implementation of Organ Culture on donor eye retrieval and the corneal transplant waiting list over a 3 year period in NSW, Australia. Retrospective review of the LNSWEB data from September 2011 to August 2014. Tissue collection, waiting list and tissue utilization data were recorded. The data from September 2008 to August 2011 for Optisol-GS storage was used for comparison. The annual donor and cornea collection rate increased 35 % and 44 % respectively with Organ Culture compared to Optisol-GS storage. The utilization rate of corneal tissue increased from 73.4 % with hypothermic storage to 77.2 % with Organ Culture storage. The transplant wait list decreased by 77.3 % from September 2011 to August 2014 and correlated with the increased rate of corneal transplantation (r = -0.9381, p < 0.0001). No other factors impacting the wait list changed over this period. Corneas not used from either storage method were due to unacceptable endothelial cell density/viability. The contamination rate of corneas stored in Organ Culture medium was low at 1.74 %. The Organ Culture storage method increases the corneal donor pool available to Eye banks. The practical benefits of the extended storage time and increased donor assessment opportunities have directly led to an increase in corneal utilization rate and a significant decrease in recipient wait list time.

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Donor Risk Factors for Graft Failure in a 20-Year Study of Penetrating Keratoplasty

Cited by 66 publications

References 23 publications

Pretreatment of Rapamycin Before Allogenic Corneal Transplant Promotes Graft Survival Through Increasing CD4+CD25+Foxp3+ Regulatory T Cells

Pretreatment of Rapamycin Before Allogenic Corneal Transplant Promotes Graft Survival Through Increasing CD4+CD25+Foxp3+ Regulatory T Cells

Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Implementation of Organ Culture storage of donor corneas: a 3 year study of its impact on the corneal transplant wait list at the Lions New South Wales Eye Bank

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