TY - JOUR
T1 - Corneal Transplantation for Infectious Keratitis
T2 - A Prospective Dutch Registry Study
AU - Veugen, Judith M. J.
AU - Dunker, Suryan L.
AU - Wolffs, Petra F. G.
AU - Savelkoul, Paul H. M.
AU - Winkens, Bjorn
AU - van den Biggelaar, Frank J. H. M.
AU - Nuijts, Rudy M. M. A.
AU - Dickman, Mor M.
AU - Netherlands Cornea Transplant Network (NCTN)
AU - Remeijer, Lies
AU - van Rooij, Jeroen
AU - Wijdh, Robert H. J.
AU - Geerards, Annette J. M.
AU - Eggink, Cathrien A.
AU - Zaal, Michel J. W.
AU - Nieuwendaal, Carla P.
AU - Stoutenbeek, Remco
AU - van Goor, Tom A.
AU - Bartels, Marjolijn C.
AU - van Dooren, Bart T. H.
AU - Henry, Ype P.
AU - Nobacht, Siamak
AU - Tang, Mei L.
AU - Wisse, Robert P. L.
AU - van der Meulen, Ivanka J.
AU - Lapid-Gortzak, Ruth
AU - van Luijk, Chantal M.
AU - Santana, Nathalie T. Y.
AU - Saelens, Isabelle
AU - Cheng, Yanny Y.
AU - Gast, Sacha
AU - Rijneveld, Annemiek
AU - van der Lelij, Allegonda
AU - Zaal, Michel
AU - de Koning Tahzib, Nayyirih
AU - Sterk, Cesar
AU - Jager, Martine
AU - van Rij, Gabriel
AU - Dhooge, Mario
AU - van Cleynenbreugel, Hugo
AU - Bleyen, Isabel
AU - Putting, Benedicte
N1 - Publisher Copyright: Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Purpose: The aim of this study was to analyze real-world practice patterns and graft survival after corneal transplantation for infectious keratitis in the Netherlands. Methods: All consecutive keratoplasties for infectious keratitis registered in the Netherlands Organ Transplant Registry were included. Graft survival was analyzed using Kaplan–Meier survival curves with Cox regression to compare the 3 most common pathogens with subgroup analysis for type and reason of transplantation, sex, and graft size. Multivariable analysis was performed using the same explanatory factors. Results: Between 2007 and 2017, 1111 keratoplasties for infectious keratitis were registered in the Netherlands Organ Transplant Registry. The most common pathogens were viruses (n = 437), bacteria (n = 271), and Acanthamoeba (n = 121). Human leukocyte antigen (HLA) matching did not provide a significant survival benefit, whereas emergency procedures showed worse graft survival [hazard ratio (HR) = 0.40, P = 0.120; HR = 2.73, P < 0.001, respectively]. Graft size >8.5 mm was significantly worse than graft size 8.5 mm (HR = 2.062, P = 0.010). In therapeutic keratoplasty, graft survival was significantly worse for Acanthamoeba than viral keratitis (HR = 2.36, P = 0.008). In the multivariable model, adjusting for graft size, type, and reason for transplantation, viral and bacterial keratitis did not differ significantly in graft survival, and Acanthamoeba showed a significantly worse prognosis (vs. viral keratitis, HR = 2.30, P < 0.001; bacterial keratitis, HR = 2.65, P < 0.001). Conclusions: Viral keratitis was the most common indication for transplantation, followed by bacterial and Acanthamoeba keratitis. HLA matching did not offer protection over elective non-HLA–matched procedures, whereas emergency procedures and grafts sized >8.5 mm showed poor survival. In optical keratoplasty, survival is high for all pathogens, whereas in therapeutic keratoplasty Acanthamoeba shows poor outcome.
AB - Purpose: The aim of this study was to analyze real-world practice patterns and graft survival after corneal transplantation for infectious keratitis in the Netherlands. Methods: All consecutive keratoplasties for infectious keratitis registered in the Netherlands Organ Transplant Registry were included. Graft survival was analyzed using Kaplan–Meier survival curves with Cox regression to compare the 3 most common pathogens with subgroup analysis for type and reason of transplantation, sex, and graft size. Multivariable analysis was performed using the same explanatory factors. Results: Between 2007 and 2017, 1111 keratoplasties for infectious keratitis were registered in the Netherlands Organ Transplant Registry. The most common pathogens were viruses (n = 437), bacteria (n = 271), and Acanthamoeba (n = 121). Human leukocyte antigen (HLA) matching did not provide a significant survival benefit, whereas emergency procedures showed worse graft survival [hazard ratio (HR) = 0.40, P = 0.120; HR = 2.73, P < 0.001, respectively]. Graft size >8.5 mm was significantly worse than graft size 8.5 mm (HR = 2.062, P = 0.010). In therapeutic keratoplasty, graft survival was significantly worse for Acanthamoeba than viral keratitis (HR = 2.36, P = 0.008). In the multivariable model, adjusting for graft size, type, and reason for transplantation, viral and bacterial keratitis did not differ significantly in graft survival, and Acanthamoeba showed a significantly worse prognosis (vs. viral keratitis, HR = 2.30, P < 0.001; bacterial keratitis, HR = 2.65, P < 0.001). Conclusions: Viral keratitis was the most common indication for transplantation, followed by bacterial and Acanthamoeba keratitis. HLA matching did not offer protection over elective non-HLA–matched procedures, whereas emergency procedures and grafts sized >8.5 mm showed poor survival. In optical keratoplasty, survival is high for all pathogens, whereas in therapeutic keratoplasty Acanthamoeba shows poor outcome.
KW - corneal transplantation
KW - graft survival
KW - infectious keratitis
UR - http://www.scopus.com/inward/record.url?scp=85174550095&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/ICO.0000000000003218
DO - https://doi.org/10.1097/ICO.0000000000003218
M3 - Article
C2 - 36737861
SN - 0277-3740
VL - 42
SP - 1414
EP - 1421
JO - Cornea
JF - Cornea
IS - 11
ER -