Long-Term Graft Survival and Decline in Endothelial Cell Density Following Penetrating Keratoplasty with Organ-Cultured Corneas

INTRODUCTION: Endothelial cell density (ECD) changes long after penetrating keratoplasty (PKP) of organ-cultured corneas have been little studied. We aim to calculate the point when ECD decline stabilises following PKP with organ culture stored corneas. METHODS: This is an observational study of first-ever PKPs and first-ever re-grafts, performed over 17 years under a single surgeon. ECDs were acquired at 3 and 6 months, 1 year post-graft and annually thereafter by specular microscopy. Time-dependent ECD data was fitted to a log-biexponential model. RESULTS: We studied 465 first-ever grafts and 128 re-grafts. Mean recipient age was 59 years (range 0–96 years; SD 22). Median follow-up was 5.7 (range 0.2–17.1) years. Probability of ED at 5 years in first grafts and re-grafts was 4.4% (2.6–7.1%) and 14.8% (8.3–23.2%). In first grafts, ECD loss reached 0.6% per annum at 7.9 (6.2–9.6) years post-operatively. The half-lives of ECD loss during the immediate post-operative period for first grafts, re-grafts, dystrophies, ectasias, and previous ocular surgery are 20.1 (14.9–30.9), 12.8 (6.9–79.4), 19.5 (13.1–37.7), 26.2 (16.2–68), and 11.6 (6.7–41.3) months, respectively. The half-life during this rapid phase of ECD loss has an inverse correlation with graft survival at 10 years (r = − 0.89, p = 0.02). CONCLUSIONS: Rate of endothelial decompensation is higher in first grafts than re-grafts. ECD decline stabilises 7.9 years post-operatively in first grafts but then becomes lower than the physiological loss expected. Further work is needed to verify whether organ-cultured grafts reach physiological levels of ECD loss faster than hypothermically stored grafts.