COMMENTARY

Corneal Transplant: Does Donor Age Matter?

Christopher J. Rapuano, MD

Disclosures

January 29, 2014

The Effect of Donor Age on Penetrating Keratoplasty for Endothelial Disease: Graft Survival After 10 Years in the Cornea Donor Study

Writing Committee for the Cornea Donor Study Research Group, Mannis MJ, Holland EJ, Gal RL, et al
Ophthalmology. 2013;120:2419-2427

Study Summary

This report looked at the 10-year results of the Cornea Donor Study (CDS), which evaluated the success rate of penetrating keratoplasty (PK) for endothelial disorders, according to donor age.

For this study, 1090 patients underwent PKs. The 10-year success rate was 77% for the 707 corneas from donors who were aged 12-65 years and 71% for the 383 corneas from donors who were aged 66-75 years; this difference was not statistically significant (P = .11). However, when analyzed as a continuous variable, older donor age was associated with lower graft clarity after the first 5 years (P < .001). The 10-year success was essentially the same (75%) for donors in the middle age group between 34 and 71 years old but was higher (96%) for the 80 donors who were 12-33 years old and lower (62%) for the 130 donors who were 72-75 years old. Because approximately 75% of donors are in the 34- to 71-year-old age group, the study authors concluded that donor age is not an important factor in most of the PKs performed for endothelial disease.

Viewpoint

The CDS was a monumental undertaking, involving 1090 patients, 80 clinical sites, and 43 eye banks. The initial study was funded for 5 years. The 5-year results showed no significant difference in graft survival between the younger and older donors. Because some interesting trends were observed at 5 years, the study was extended to 10 years. Of the 765 patients eligible for participation in the 10-year phase, 662 (87%) did so. A total of 445 (41%) patients completed the 10-year follow-up without graft failure, and another 129 (19%) patients completed between 5 and 10 years of follow-up without graft failure.

Overall, the 10-year results continued the trend found at 5 years, namely that older donor tissue was associated with a lower endothelial cell count and a higher rate of graft failure. When this was analyzed further, the graft survival rate was fairly constant for most donor ages (between 34 and 71 years), although it was higher for younger donors (12-33 years old) and slightly worse for older donors (72-75 years old).

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