Risk factors for corneal graft failure and rejection in the collaborative corneal transplantation studies. Collaborative Corneal Transplantation Studies Research Group.
Risk factors for corneal graft failure and rejection in the collaborative corneal transplantation studies. Collaborative Corneal Transplantation Studies Research Group.
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DOI：
10.1016/s0161-6420(94)31138-9
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发表时间：
1994-09
期刊：
影响因子：
13.7
通讯作者：
M. Maguire;W. Stark;J. Gottsch;R. Stulting;A. Sugar;N. Fink;A. Schwartz
中科院分区：
文献类型：
--
作者：
M. Maguire;W. Stark;J. Gottsch;R. Stulting;A. Sugar;N. Fink;A. Schwartz
目的：综合评价角膜移植术后角膜移植失败高危患者因任何原因导致的角膜移植失败、排斥反应导致的角膜移植失败和免疫反应的可疑危险因素的大小。方法：对457例参与角膜移植研究的患者进行回顾性分析。所有参与者至少有两象限间质血管形成和/或有移植排斥史或既往排斥。患者随访2 ~ 5年。检查患者、研究眼、供体、供体-受体组织相容性和手术方式的特征，以确定它们与任何原因导致的移植失败、排斥失败和免疫反应的关系。多变量生存分析技术用于估计移植物结局事件的发生率和估计危险因素的大小。结果：在调整其他危险因素后，许多明显的危险因素与移植物预后的相关性不再维持。年轻的受者年龄、以前的移植物数量、以前的前段手术史、术前青光眼、前粘连象限、间质血管象限、化学烧伤的初步诊断和ABO血型不相容是移植物失败的最强危险因素。供体和角膜保存特性对移植结果影响不大。结论：即使在高危人群中，移植物衰竭的风险也存在很大差异。在考虑移植和计划随访时，患者和外科医生应考虑存在的风险因素的数量。
Purpose:To evaluate comprehensively the magnitude of suspected risk factors for corneal graft failure from any cause, failure from rejection, and immunologic reaction in patients at high risk for graft failure after corneal transplantation.Methods:The records of the 457 participants in the Collaborative Corneal Transplantation Studies were reviewed. All participants had at least two quadrants of stromal vascularization and/or a history or previous graft rejection. Patients were followed for 2 to 5 years. Characteristics of the patient, study eye, donor, donor-recipient histocompatibility, and surgical procedure were examined for their association with the graft outcomes of failure from any cause, rejection failure, and immunologic reaction. Multivariate survival analysis techniques were used to estimate rates of graft outcome events and to estimate the magnitude of risk factors.Results:Many apparent risk factors did not maintain their association with graft outcomes after adjustment for other risk factors. Young recipient age, the number of previous grafts, history of previous anterior segment surgery, preoperative glaucoma, quadrants of anterior synechiae, quadrants of stromal vessels, a primary diagnosis of chemical burn, and blood group ABO incompatibility were among the strongest risk factors identified for graft failure. Donor and corneal preservation characteristics had little influence on graft outcome.Conclusions:Risk of graft failure varies substantially, even within a high-risk population. The number of risk factors present should be considered by the patient and surgeon when contemplating transplantation and planning follow-up.