Corneal graft rejection 10 years after penetrating keratoplasty in the Cornea Donor Study

Steven P. Dunn, Robin L. Gal, Craig Kollman, Dan Raghinaru, Mariya Dontchev, Christopher L. Blanton, Edward J. Holland, Jonathan H. Lass, Kenneth R. Kenyon, Mark J. Mannis, Shahzad I. Mian, Christopher J. Rapuano, Walter J. Stark, Roy W. Beck, R. L. Gal, C. Kollman, D. Raghinaru, M. Dontchev, R. W. Beck, J. H. LassM. J. Mannis, C. J. Rapuano, C. L. Blanton, E. J. Holland

Research output: Contribution to journalArticle


Purpose: The aim of this study was to assess the effect of donor and recipient factors on corneal allograft rejection and evaluate whether a rejection event was associated with graft failure. Methods: One thousand ninety subjects undergoing penetrating keratoplasty for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 12 years. Associations of baseline recipient and donor factors with the occurrence of a rejection event were assessed in univariate and multivariate proportional hazards models. Results: Among 651 eyes with a surviving graft at 5 years, the 10-year graft failure (699% confidence interval) rates were 12% ± 4% among eyes with no rejection events in the first 5 years, 17% ± 12% in eyes with at least 1 probable, but no definite rejection event, and 22% ± 20% in eyes with at least 1 definite rejection event. The only baseline factor significantly associated with a higher risk of definite graft rejection was a preoperative history of glaucoma, particularly when previous glaucoma surgery had been performed and glaucoma medications were being used at the time of transplant (10-year incidence 35% ± 23% compared with 14% ± 4% in eyes with no history of glaucoma/intraocular pressure treatment, P = 0.008). Conclusions: Patients who experienced a definite rejection event frequently developed graft failure raising important questions as to how we might change acute and long-term corneal graft management. Multivariate analysis indicated that previous use of glaucoma medications and glaucoma filtering surgery was a significant risk factor related to a definite rejection event.

Original languageEnglish (US)
Pages (from-to)1003-1009
Number of pages7
Issue number10
Publication statusPublished - Oct 1 2014



  • Corneal graft failure
  • Corneal graft rejection
  • Penetrating keratoplasty

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)

Cite this

Dunn, S. P., Gal, R. L., Kollman, C., Raghinaru, D., Dontchev, M., Blanton, C. L., ... Holland, E. J. (2014). Corneal graft rejection 10 years after penetrating keratoplasty in the Cornea Donor Study. Cornea, 33(10), 1003-1009.