Epidemiology And Risk Factors For Corneal Graft Rejection In A Developing Country

To determine corneal graft rejection rate and identify the risk factors for rejection in the population of a national reference center in a developing country.

Cornea Service of National Ophthalmology Unit, Guatemala City, Central America.

Retrospective observational study of patients of all age groups who underwent penetrating keratoplasty (PKP), after signing the consent form, from January 2017 to December 2022. The clinical data were obtained from medical records following ethical guidelines. The minimum follow-up was 12 months to evaluate graft evolution and the main outcome measure was receptor risk factors associated to graft rejection, defined as loss of graft transparency secondary to immunological response of the host cornea to the donor corneal button. Patients were informed about the clinical signs for which they had to urgently consult.

198 eyes of 198 patients who underwent keratoplasty with optic purposes were included. Age range was 1 to 86 years (mean, 38 years), 48 grafts (24%) were of patients under  16 years of age. There were 126 men (63.4%) and 72 women (36.6%). Immunologic rejection of the corneal graft occurred in 29 cases (frequency of rejection = 14.65%). The identified receptor risk factors for graft rejection were age less than 16 years, preoperative indication for surgery, and glaucoma (p < 0.05). Graft rejection was developed in 75% of anterior segment dysgenesis, 41% of previous corneal graft rejection, 31% of corneal opacity of infectious origin and 21% of traumatic corneal opacity meanwhile in keratoconus rejection rate was 2%.

In a national reference center of a developing country, corneal transplantation has a rejection rate similar to results reported by other authors as well as a high rate of success. These results suggest that younger receptor age and glaucoma are the main risk factors for corneal graft rejection in recipients. Graft rejection was also more frequent in patients with preoperative indication of anterior segment dysgenesis, previous rejection, and corneal opacity due to infectious and traumatic etiology. Corneal transplantation seems to be an effective and safe procedure, but rejection must be treated early to not endanger graft success along with long term follow-up. More patient data and prospective clinical trials are needed.