Ong Hon Shing, Chiam Nathalie, Htoon Hla Myint, Kumar Ashish, Arundhati Anshu, Mehta Jodhbir S
Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore.
Singapore Eye Research Institute, Singapore, Singapore.
Front Med (Lausanne). 2022 Jan 27;8:801472. doi: 10.3389/fmed.2021.801472. eCollection 2021.
Corneal transplantations are the commonest allogenic transplant surgeries performed worldwide. Transplantable grade donor cornea is a finite resource. There is thus an impetus for eye banks to optimize the use of each harvested cornea, and clinicians to minimize the risks of graft rejection and failure. With better survival and lower rejection rates, anterior lamellar keratoplasty has gained popularity as an alternative technique to full-thickness penetrating keratoplasty, for the treatment of corneal stromal diseases. This study evaluated the effects of donor-recipient age- and sex-matching on the outcomes of eyes that had undergone deep anterior lamellar keratoplasty (DALK) surgeries.
Observational cross-sectional study (national corneal graft registry data).
All DALK surgeries performed in a tertiary ophthalmic hospital over an 11-year period.
To analyse the effects of donor-recipient sex-matching, transplantations were classified as "presumed H-Y incompatible" (male donor to female recipient) or "presumed H-Y compatible" (all other donor-recipient sex combinations). For age-matching, differences in donor and recipient ages were calculated. Cox proportional hazards regressions were used to evaluate the influence of donor-recipient sex-matching and age-matching on graft failure and rejection.
Rates of graft failure and rejection within each group.
401 eyes were included. 271 (67.6%) transplants were presumed H-Y compatible. 29 (7.2%) grafts failed and 9 (2.2%) grafts rejected. There were trends of lower hazard ratios (HRs) in graft failure and rejection in the presumed H-Y compatible group [HRs: 0.59 (95% CI 0.20-1.77, = 0.34) and 0.93 (95% CI 0.22-3.89, = 0.926), respectively]. Median difference in age between recipients and donors was 15.0 years (IQR -2.8-34.3). The HRs of graft failure and rejection were not influenced by donor-recipient age [HRs per 1-year increase in age difference: 0.995 (95% CI 0.98-1.01, = 0.483) and 1.01 (95% CI 0.99-1.03, = 0.394), respectively].
In eyes that had undergone DALK surgeries, no significant influence of donor-recipient sex- or age-matching on graft rejection and failure was observed. Without strong evidence and the limitations of obtaining sample sizes required for an adequately powered study, the benefits of sex- and age-matching of donors and recipients during graft allocation for DALK surgeries is currently inconclusive.
角膜移植是全球最常见的同种异体移植手术。可移植级别的供体角膜是一种有限的资源。因此，眼库有动力优化每片采集角膜的使用，临床医生也有动力将移植排斥和失败的风险降至最低。由于具有更好的存活率和更低的排斥率，前板层角膜移植术作为全层穿透性角膜移植术的替代技术，在治疗角膜基质疾病方面越来越受欢迎。本研究评估了供体与受体年龄和性别匹配对接受深前板层角膜移植术（DALK）手术的眼睛预后的影响。
观察性横断面研究（国家角膜移植登记数据）。
一家三级眼科医院在11年期间进行的所有DALK手术。
为分析供体与受体性别匹配的影响，移植被分为“假定H-Y不相容”（男性供体至女性受体）或“假定H-Y相容”（所有其他供体与受体性别组合）。对于年龄匹配，计算供体和受体年龄的差异。使用Cox比例风险回归来评估供体与受体性别匹配和年龄匹配对移植失败和排斥的影响。
每组内的移植失败率和排斥率。
纳入401只眼睛。271例（67.6%）移植被假定为H-Y相容。29例（7.2%）移植失败，9例（2.2%）移植发生排斥。在假定H-Y相容组中，移植失败和排斥的风险比（HRs）有降低趋势[HRs分别为：0.59（95%CI 0.20 - 1.77，P = 0.34）和0.93（95%CI 0.22 - 3.89，P = 0.926）]。受体与供体年龄的中位数差异为15.0岁（IQR - 2.8 - 34.3）。移植失败和排斥的HRs不受供体与受体年龄的影响[年龄差异每增加1岁的HRs分别为：0.995（95%CI 0.98 - 1.01）和1.01（95%CI 0.99 - 1.03），P分别为0.483和0.394]。
在接受DALK手术の眼睛中，未观察到供体与受体性别或年龄匹配对移植排斥和失败有显著影响。由于缺乏有力证据以及难以获得足够样本量以进行有充分统计学效力的研究，目前在DALK手术的移植物分配过程中，供体与受体性别和年龄匹配的益处尚无定论。
