Possible Correlation Between Chemotherapy Treatment Of Corneal Donors To Lower Endothelial Cell Density Of Their Grafts

Corneal grafts endothelial cell count is a key factor indicating graft's quality and suitability for transplantation. Several factors are known to influence the donor's cell count: donor's age, donor's ocular surgeries, trauma, genetic diseases, etc. Oncological treatments such as chemotherapy may lead to systemic effects that could also potentially affect the status of corneal tissues. At present, there are no studies demonstrating lower endothelial cell density in donors corneas recieved prior-to-death chemotherapy. The aim of this study was to investigate whether there is such a correlation

Eye bank records of a tertiary hospital in Israel

Corneal transplants data was collected from the records of the Rabin medical center eye bank, for the years 2014-2024. Data of donors recieving prior-to-death chemotherapy was compared to an age-matched control group of donors that did not recieve chemotherapy. Data included graft's endothelial cell density (ECD), donor's ocular and systemic medical history, donors chemotherapy regimen received, and radiation therapy to the head-neck area. All cell counting was performed by the same examiner in a manual fashion (and not automatic) 

471 corneal grafts of donors recieving chemotherapy prior-to-death were identified. A control group of 471 age-matched consecutive donors that did not recieve chemotherapy was collected. Average death age was 65 in both groups. The average time from death to graft’s processing was 1.1 days. There was no difference between the groups regarding sex, death-to-processing time, and cell density of donors received head/neck radiation. The comparison of ECD between the groups yielded the following results: Up to 40 y/o: 2694.2 vs. 2993.1 (p=0.024, n=13). 40-50 y/o: 2652 vs. 2596.4 (p=0.44, n=31). 50-60 y/o: 2377.9 vs. 2656.4 (p=0.006, n=90). 60-70 y/o: 2242.6 vs. 2522.0 (p=0.00001, n=149). 70 y/o and above: 2119.3 vs. 2264.1 (p=0.75, n=188)

Our findings suggest that chemotherapy may lead to endothelial cell loss in donor corneal grafts, in different age groups. To the best of our knowledge, this observation was not previously described. Lower ECD seen in the chemotherapy group could lead to suboptimal outcomes of corneal transplant procedures and could be an important history detail in selecting grafts for transplantation. An effort is currently made to identify the exact compounds and chemotherapy regimens that may be responsible for the lower ECD seen in different age groups of corneal donors.