TOPICAL TACROLIMUS IN HIGH-RISK CORNEAL TRANSPLANT REJECTION PREVENTION

High risk corneal grafts have high levels of rejection due to loss of immunological privilege, with no consensus as to which immunosuppressants should be used. Previous studies showed graft survival rates of 30% at 10 years. The purpose of this study was to assess the use of topical tacrolimus ointment in preventing rejection in these cases, when added to the standard immunosuppressive regimen. 

Patients submitted to penetrating keratoplasty in the Ophthalmology Department of Coimbra Hospital and University Centre. 

We retrospectively analysed post-operative data of high-risk patients, who were treated with topical tacrolimus ointment 0.2mg/g twice a day plus topical dexamethasone 0.1mg/ml 6 id and compared it with a control treated with topical corticotherapy only. The information was gathered from the clinical files. High-risk status was attributed to patients with history of previous graft rejection. The control  group consisted of patients with a similar high risk corneal graft treated with topical dexamethasone 0.1mg/ml 6 id alone.  

We analysed 53 patients in the trial group versus 53 patients in the control group, with similar age, baseline diagnosis and risk factors, and median follow-up times of 30 and   and 24 months, respectively. Survival analysis showed a higher graft survival rate at all follow-up periods for patients treated with topical tacrolimus (p<0,01). No adverse reactions were reported. 

This study shows that topical tacrolimus ointment increases the survival rate of the graft if added to the previous topical steroid regimen in high-risk patients.