New data from UK Transplant Registry shows similar 2-year rejection rates for full thickness and endothelial corneal transplants in first-time recipients
Corneal transplantation involves the replacement of damaged cornea with donor tissue. For some of the commonest forms of corneal disease, there are currently two primary approaches to transplantation: Full-thickness, or penetrating keratoplasty (PK), which involves the replacement of the entire cornea, and endothelial keratoplasty (EK), which involves the selective replacement of the diseased layer of the cornea, leaving healthy areas intact. Over the past 15 years, EK has emerged as the preferred form of transplantation in cases of visual loss due to endothelial dysfunction. EK offers a number of advantages, by comparison with PK, including possible lower incidence of transplant rejection.
However, the theoretical advantages of EK have not always been reflected in the clinical data. To date, published studies have reported widely variable rates of rejection and subsequent graft failure following EK.
Newly published data from the UK Transplant Registry has provided further evidence that EK does not result in a lower incidence of transplant rejection and graft failure. The authors of ‘Transplant Rejection Following Endothelial Keratoplasty and Penetrating Keratoplasty in the United Kingdom: Incidence and survival’ report the results of 3,486 corneal transplants carried out in the UK for two specific corneal diseases and conclude that ‘there is no significant difference in rejection-free survival between EK and PK.’ They also report that the presence of inflammation can be an important risk factor for rejection suggesting that attention to its control before and following surgery is important. This finding highlights the importance of VISICORT’s work to investigate the markers of transplant rejection and to develop new therapies to control post transplant inflammation.
Prof. Jesper Hjortdal (Aarhus University Hospital), who leads the VISICORT Clinical Study Group comments: Immune reactions (rejection episodes) towards transplanted corneal tissues are common and a rejection episode often results in failure of the corneal graft. In the UK study follow-up was missing for 10-20% of the operated patients, which actually is superior compared with many other registries. Smaller, single clinic studies have been in-line with the UK Transplant Registry Study, although a tendency to lower rejection rates for EK was found in patients with Fuchs endothelial dystrophy (1,2). Prospective, longer-term studies extending beyond a 2-year follow-up are needed to further evaluate risk factors for immune reactions. VISICORT will provide such data within the coming years.
1. Hjortdal J, Pedersen IB, Bak-Nielsen S, Ivarsen A. Graft rejection and graft failure after penetrating keratoplasty or posterior lamellar keratoplasty for fuchs endothelial dystrophy. Cornea. 2013 May;32(5):e60-3.
2. Pedersen IB, Ivarsen A, Hjortdal J. Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure. Acta Ophthalmol. 2015 Mar;93(2):172-7.