Corneal Graft Rejection

Author: Jason Jacobs, MD; Chief Editor: Hampton Roy Sr, MD more...

Updated: Feb 17, 2010

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Background
Pathophysiology
Epidemiology
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Background

Although described for more than 100 years, corneal transplantation has become increasingly common since the 1960s. Over 40,000 transplants were performed in 1990 in the United States and Canada. The 5-year failure rate for corneal grafts is approximately 35%; corneal graft rejection is the most common cause of graft failure in the late postoperative period.

Examples of corneal graft rejection are shown in the images below.

This severely vascularized cornea would be at high risk for graft rejection following a penetrating keratoplasty. This patient experienced Stevens-Johnson syndrome.

This is an example of an acute graft rejection episode. Note the graft edema, Descemet folds, and keratic precipitates.

Pathophysiology

The term graft rejection refers to the specific immunologic response of the host to the donor corneal tissue. Because it is a specific process, it should be distinguished from other causes of graft failure that are not immune mediated. A corneal graft that has suffered this immunologic response may or may not ultimately fail. Some physicians distinguish between graft reaction, which is reversible with medical therapy, and graft rejection, in which the immunologic end stage has been reached and the process is irreversible. Other physicians simply use graft rejection to refer to this immunologic process at any stage of its development, noting that some cases progress to graft failure because of rejection. This second terminology is used in this article because it is in line with terminology used in other types of organ transplantation.

Furthermore, at the time of presentation, determining with certainty whether an immune process is reversible is impossible.

Frequency

United States

Over 40,000 transplants were performed in 1990 in the United States and Canada. The 5-year failure rate for corneal grafts is approximately 35%.

Mortality/Morbidity

Corneal graft rejection is the most common cause of graft failure in the late postoperative period.

Race

No difference in corneal graft rejection between different races is known.

Sex

No sex predilection for corneal graft rejection is known.

Age

Host age may influence the risk of corneal graft rejection. Some investigators have concluded that a lower risk of corneal graft rejection is present in hosts who are older than 60 years, although this is not certain. Infants are thought to have higher rates of graft rejection than adults.

Proceed to Clinical Presentation

Contributor Information and Disclosures

Author

Jason Jacobs, MD Clinical Faculty, Department of Ophthalmology, University of Colorado Health Sciences Center

Jason Jacobs, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, International Society of Refractive Surgery, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Taravella, MD Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Professor, Department of Ophthalmology, University of Colorado School of Medicine

Michael Taravella, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, and Eye Bank Association of America

Disclosure: Alcon Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching; Surgical Specialties Honoraria Speaking and teaching; BD Surgical Supplies Honoraria Speaking and teaching

Specialty Editor Board

Jack L Wilson, PhD Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis

Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

Lance L Brown, OD, MD Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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