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Corneal grafts from donors up to 75 years old may be suitable for transplantation

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Corneal grafts obtained from donors aged 66 years and older appear to have a 5-year survival rate, similar to grafts obtained from donors younger than 66 years, when transplanted onto patients who have a moderate risk of graft failure, according to a prospective, randomized study.

"Surgeons and patients now have evidence that corneas comparable in quality to those used in this study from donors through age 75 [years] are suitable for transplantation," the study authors said.

Robin L. Gal, MSPH, and 105 surgeons at 80 participating centers evaluated outcomes for corneal transplants performed on 1,090 patients for moderate-risk conditions, primarily Fuch's dystrophy or pseudophakic corneal edema. In all cases, surgeons used donor corneas with endothelial cell densities between 2,300 cells/mm² and 3,300 cells/mm² obtained from donors aged 12 years to 75 years.

Of the 1,090 patients, 707 patients received corneas from donors aged younger than 66 years and 383 patients received corneas from donors aged 66 years and older.

After evaluating for donor age as a continuous variable, the investigators found no significant relationship between donor age and graft survival. Overall, there was an 86% cumulative 5-year graft survival rate, according to the study.

However, in an exploratory analysis, transplants involving corneas from donors younger than 66 years yielded slightly higher success rates. But "because such a small proportion of the donor pool consists of corneas from young donors, this observation, even if real, has limited applicability," the authors noted.

Overall, there were 135 graft failures, with regrafting performed in 102 cases. Causes of graft failure did not vary significantly between donor age groups, according to the study.

"Three graft failures were due to primary donor failure, eight to uncorrectable refractive error, 48 to graft rejection, 46 to endothelial decompensation and 30 to other causes," the authors said.

The study, called the Cornea Donor Study, is published in the April issue of Ophthalmology.