Lost to follow-up: reasons and characteristics of patients undergoing corneal transplantation at Tenwek Hospital in Kenya, East Africa

Abstract

Introduction corneal transplantation is a surgical procedure requiring consistent long-term follow-up to maximize the chance of graft survival. The purpose of this study was to explore patient characteristics and reasons for being lost to follow-up (LTFU). Methods a retrospective review of clinical records from January 2012 to October 2014 was conducted of patients who received corneal transplantation at Tenwek Hospital. At the time of chart review, all patients who provided a mobile phone number were contacted to answer a phone questionnaire. Logistic regression was used to assess the association of each patient characteristic, separately, with the outcome of LTFU. Results of the 118 patients that met inclusion criteria, 40 (33.9%) were considered LTFU by failing to follow up at Tenwek Hospital to at least one year postoperatively. The odds of LTFU for patients age 60 and older were 3.78 times that of those who were 18-59 (95% CI: 1.21-11.80]; p-value=0.02). The odds of LTFU for patients with a preoperative diagnosis of pseudophakic bullous keratopathy were 3.83 times that of those with a preoperative diagnosis of keratoconus (95% CI: [1.13-12.94]; p-value=0.03). Education level, employment status, distance from the hospital, and possession of a mobile contact number appeared marginally associated with follow-up status, though not statistically significant at the 0.05 significance level. Financial barriers were the most commonly cited reason for LTFU (42.4%, n=14). Conclusion certain reasons and patient characteristics may be associated with follow-up adherence. Identifying these factors may help providers identify patients who are at a higher risk of LTFU and influence providers in medical decision-making and system-based interventions when offering corneal transplantation.

Current social determinants of health and social risk factors in conditions of the cornea: a scoping review

“…All included articles and the identified SDoH in each study are summarized in Table 1. Dry eye/ocular surface [18 ▪▪ ,19 ▪ –38 ▪ ] (21 articles) was the most prevalent cornea condition, followed by pterygium [39 ▪▪ ,40 ▪ –42 ▪ ] (4 articles), keratoplasty [43 ▪▪ ,44–46] (four articles), keratoconus [47 ▪ ,48,49] (three articles), cornea donation [50,51 ▪▪ ,52 ▪▪ ] (three articles), cornea thickness [53 ▪ ,54 ▪ ] (two articles), trachoma [55 ▪▪ ,56] (two articles), corneal ulcers [57 ▪ ,58 ▪ ] (two articles), corneal arcus [59 ▪ ] (one article), and corneal opacity[60 ▪ ] (one article). Cornea donation for transplantation was also explored.…”

Lost-to-follow-up

“…This is considerably lower compared to the 63.1% seen in the study by Ikpoh et al . [ 9 ] As per the Australian Corneal Graft Registry report from 2021, approximately 10% of all grafts are lost without any follow-up. In 3% of cases, the recipients died.…”

“…This is similar to the conclusion by Ikpoh et al . [ 9 ] This can be attributed to a greater risk of associated comorbidities or a lack of caretakers to accompany them to the center. Dementia is also a factor in solid organ transplant patients.…”

“…This correlates with the study by Ikpoh et al . [ 9 ] In contrast, Crawford et al . found an inverse correlation between distance and adherence to follow-up.…”

“…This is of particular interest in patients from the lower socio-economic strata, where the economic burden and area of residence may hinder regular follow-up. [ 8 , 9 ]…”