Factors Associated With Graft Rejection in the Cornea Preservation Time Study.
Factors Associated With Graft Rejection in the Cornea Preservation Time Study.
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DOI：
10.1016/j.ajo.2018.10.005
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发表时间：
2018-12
影响因子：
4.2
通讯作者：
Cornea Preservation Time Study Group
中科院分区：
文献类型：
--
作者：
Stulting RD;Lass JH;Terry MA;Benetz BA;Cohen NJ;Ayala AR;Maguire MG;Croasdale C;Daoud YJ;Dunn SP;Goins KM;Gupta PC;Macsai MS;Mian SI;Pramanik S;Rose-Nussbaumer J;Song JC;Stark WJ;Sugar A;Verdier DD;Szczotka-Flynn LB;Cornea Preservation Time Study Group
在角膜保存时间研究 (CPTS) 中确定与后弹力层剥离自动内皮角膜移植术 (DSAEK) 后移植物排斥相关的因素。多中心随机临床试验中的队列研究。接受 DSAEK 的 1090 名受试者的 1330 只眼睛被随机接受保存时间 (PT) 为 0-7 天 (N=675) 或 8-14 天 (N=655) 的供体角膜，并随访三年。中央内皮细胞密度（ECD）由中央图像分析读取中心测定。根据 PT、受者诊断和外科医生效果调整的多变量 Cox 模型用于识别与排斥相关的因素。明确移植物排斥的累积概率为 3.6%（99% CI 2.5% 至 5.3%）。受者年龄较小与移植物排斥相关[p<0.001； HR：每十年 0.53 (0.33, 0.83)]。 PT、供体-受体性别不匹配、受体诊断、受体种族、移植物大小、局部皮质类固醇和免疫调节剂的停用、三个月内既往免疫接种以及既往青光眼手术与排斥反应无关（p>0.01）。在基线和 3 年进行 ECD 测量的透明移植物中 (N=913)，经历过排斥反应的眼睛 (N=27) 的内皮细胞损失 (ECL) 比没有经历过排斥反应的眼睛 (N=886) 更大（48% vs 38%，p=0.03）。 44 只眼睛中，有 12 只（27%）出现明确的移植排斥反应，随后失败，占 CPTS 79 只失败眼中的 15%。 DSAEK 后移植物排斥并不常见，而且在年龄较小的情况下更有可能发生，在研究队列中，大多数年龄都 > 50 岁。拒绝会增加 ECL，但并不是 DSAEK 失败的主要原因。
To identify factors related to graft rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS). Cohort study within a multicenter randomized clinical trial. 1330 eyes of 1090 subjects undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0–7 days (N=675) or 8–14 days (N=655) and followed for three years. Central endothelial cell density (ECD) was determined by a central image analysis reading center. Multivariable Cox models adjusted for PT, recipient diagnosis, and surgeon effect were used to identify factors associated with rejection. Cumulative probability of definite graft rejection was 3.6% (99% CI 2.5% to 5.3%). Younger recipient age was associated with graft rejection [p<0.001; HR: 0.53 (0.33, 0.83) per decade]. PT, donor-recipient gender mismatch, recipient diagnosis, recipient race, graft size, discontinuation of topical corticosteroids, and immune-modulators, prior immunizations within three months, and prior glaucoma surgery were not associated with rejection (p>0.01). Among clear grafts with an ECD measurement at baseline and 3 years (N=913), endothelial cell loss (ECL) was greater in eyes that experienced a rejection episode (N=27) than in those that did not (N=886) (48% vs 38%, p=0.03). Twelve of 44 eyes (27%) with definite graft rejection subsequently failed, comprising 15% of the 79 failures in the CPTS. Graft rejection is uncommon after DSAEK and more likely with younger age, in a study cohort mostly > 50 years old. Rejection increases ECL, but it is not a leading cause of DSAEK failure.
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DOI：
10.1111/j.2044-8317.1992.tb00992.x
发表时间：
1992-11-01
影响因子：
2.6
作者：
DERKSEN, S;KESELMAN, HJ
通讯作者：
KESELMAN, HJ
影响因子：
2.8
作者：
Allan, Bruce D. S.;Terry, Mark A.;Claesson, Margareta
通讯作者：
Claesson, Margareta
影响因子：
8.1
作者：
Lass, Jonathan H.;Benetz, Beth Ann;Tramber, Michael
通讯作者：
Tramber, Michael
影响因子：
4.1
作者：
Jordan, C. S.;Price, M. O.;Price, F. W., Jr.
通讯作者：
Price, F. W., Jr.
影响因子：
2
作者：
Benetz, BA;Gal, RL;Lass, JH
通讯作者：
Lass, JH