Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 15, Pages -Publisher
MDPI
DOI: 10.3390/jcm10153426
Keywords
corneal graft; donor cornea; corneal banking; suitability for transplantation; death-to-explantation interval; endothelial cell density
Categories
Funding
- Deutsche Ophthalmologische Gesellschaft
- Bayer Vital
- Novartis
- Heidelberg Engineering
- Berufsverband der Augenarzte Deutschlands e.V.
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In Germany, over one-third of donor corneas are unsuitable for transplantation. Factors such as donor age, sex, lens status, and death-to-explantation interval (DEI) influence the usability of donor corneas. A mathematical model for better donor preselection is proposed to address the growing need for donor corneas.
Background: In Germany, more than one-third of donor corneas harvested are not suitable for transplantation. We evaluated the factors associated with the usability of donor corneas. Method: Data from 2032 consecutive donor corneas harvested at the Rhineland-Palatinate Eye Bank in Mainz, Germany, were retrospectively analyzed. Factors of interest were age, sex, lens status, cause of death, cardiopulmonary resuscitation (CPR), death-to-explantation-interval (DEI), and the influence of these factors on the proportion of discarded donor corneas. Factors associated with endothelial cell density (ECD) were analyzed in a linear regression mixed model. Results: Higher donor age, male gender, pseudophakic lens status, and longer DEI were associated with significantly reduced ECD. With respect to DEI, the estimated cell loss was 7 +/- 2 cells/mm(2)/hour (p < 0.001). Age was associated with a lower ECD of 6 +/- 2 cells/mm(2) per year (p = 0.001). Female ECD was 189 +/- 44 cells/mm(2) higher than male ECD (p < 0.001). Pseudophakic eyes had 378 +/- 42 cells/mm(2) less compared with phakic eyes (p < 0.001). Cause of death did not affect the ECD. Of note, 55% and 38% of corneas harvested on the second and third postmortem day, respectively, and 45% of corneas from donors older than 80 years were still suitable for transplantation. Conclusions: In the context of a growing need for donor corneas, we do not recommend limiting donor age and collection time to 24 h or excluding oncology donors, as is the practice in many countries. Therefore, we propose a mathematical model for better donor preselection.
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