Clinical Course of Different Types of Immune Reactions following Keratoplasty

Abstract

Background Immune-mediated corneal graft rejection (IR) is a leading cause of corneal graft failure. The endothelium, stroma, epithelium, or a combination can be affected. Little is known about the long-term outcomes of different types of IR.

Methods We reviewed the medical records of all keratoplasties that had been performed at our eye centre between 2003 and 2016 (n = 3934) for any kind of IR that occurred between the surgery and 2019. All patients with a definite diagnosis of IR and sufficient clinical data were included in the analysis. IRs were grouped according to the affected part of the graft (endothelial, stromal, epithelial, and mixed). We analysed the dynamics of recovery and the clinical outcomes.

Results We identified a total of 319 patients with IR. Twenty-seven of those were lost to follow-up and were excluded from further analysis. Of the IRs, 89% affected the endothelium. Endothelial IR resulted more frequently in a considerable loss of endothelial cell density than other forms of IR. Stromal IR showed a lower relapse rate and a better visual recovery than other types of IR and resulted less often in a failure of the graft.

Conclusions We herein report comprehensive data about the prognosis regarding functional recovery after different types of IR following keratoplasty. Our data underline that timely recognition and correct classification of IR are important because they determine the clinical course and prognosis.

Zusammenfassung

Hintergrund Die Transplantatabstoßung ist ein Hauptgrund für ein Transplantatversagen nach Hornhautübertragung. Dabei können das Endothel, das Stroma, das Epithel oder eine Kombination davon betroffen sein. Über die klinischen Verläufe nach den verschiedenen Abstoßungsformen ist wenig bekannt.

Methoden Es wurden die Krankenakten von sämtlichen Patienten nach Hornhauttransplantation analysiert, die zwischen 2003 und 2016 in unserer Klinik durchgeführt wurden (n = 3934). Alle Patienten mit einer immunologischen Transplantatabstoßung wurden in die Analyse aufgenommen. Die Patienten wurden nach der führenden Abstoßungskomponente gruppiert (endothelial, stromal, epithelial und gemischt). Wir analysierten die klinischen Ergebnisse im Verlauf.

Ergebnisse Insgesamt wurden 319 Patienten mit einer immunologischen Abstoßungsreaktion identifiziert. 27 Patienten wurden mangels Nachuntersuchungsdaten nicht weiter ausgewertet. 89% der Immunreaktionen betrafen das Endothel. Endotheliale Abstoßungsreaktionen führten häufiger zu einem signifikanten Verlust von Endothelzellen als andere Formen der Abstoßung. Stromale Immunreaktionen zeigten eine geringere Rezidivrate und eine schnellere Erholung der Sehschärfe als andere Formen von Immunreaktionen und führten auch seltener zu einem Transplantatversagen.

Schlussfolgerungen Wir berichten hier über die Prognose nach verschiedenen Arten der Immunreaktion nach Keratoplastik. Die rechtzeitige Erkennung und korrekte Klassifizierung von Immunreaktionen sind wichtig für die Prognose des klinischen Verlaufs.

Key words

corneal graft rejection - keratoplasty - clinical registry data

Schlüsselwörter

Hornhauttransplantatabstoßung - Hornhauttransplantation - Abstoßungsregister

^* P. K. and T. L. contributed equally to the work presented here and should therefore be regarded as equivalent authors.

Publication History

Received: 08 February 2021

Accepted: 05 July 2021

Article published online:
11 August 2021

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