Topical tacrolimus in cornea transplant rejections
First Author: L.Bernardes PORTUGAL
Co Author(s): J. Gil A. Rosa E. Costa M. Quadrado J. Murta
High risk corneal grafts have high levels of rejection due to loss of immunological privilege, with no consensus as to which immunosuppression should be used. Previous studies showed graft survival rates of less than 35% at 10 years, with no improvement of these values during the last decades. The purpose of this study was to assess the benefits of topical tacrolimus ointment in preventing rejection in these cases, when added to the previous immunosuppression regimen.
Addition of topical tacrolimus ointment to the post-graft imunossupressive regimen for high risk patients at Centro Hospitalar e Universitário de Coimbra Ophthalmology Department.
We retrospectively analised post-operative data of high risk patients who used an immunosuppression regimen with topical tacrolimus ointment 0.2mg/g twice a day. The information was gathered from the clinical files. High - risk status was attributed to patients with history of previous graft rejection or at least two quadrants of stromal neovascularitization. The controls were the previous grafts in the same group of patients.
We studied 25 patients, 12 males and 13 females, with a median age of 62,94 ± 18,50 years (media ± standard deviation). During a follow-up of 20.00 ± 9.83 months, about 18,8% of patients in the study group experienced transplant rejection, compared to 100% of patients in the control group. Median graft failure time was 9.50 ±48.77 months. The median follow up of the control group (previous transplant without tacrolimus) was 14,00 ± 50.33 months.
Our study shows that topical tacrolimus ointment increases the survival rate of the graft if added to the previous topical steroid regimen. Conclusion: Topical tacrolimus ointment appears to be safe and effective in prolonging graft survival in high-risk patients.