Corneal transplantation: The forgotten graft

The most commonly performed transplant is that of the cornea, with 2292 corneal grafts performed in the UK in 2002-03, compared with 1775 renal transplants [1]. In the USA approximately 40 000 transplants are performed every year [2]. However this preponderance is not reflected in the amount of attention given to this transplanted tissue by the scientific community: for example up till now there have been no papers published in the American Journal of Transplantation that have cornea as a key or title word (as determined by a Med-line search in December 2003). There are several reasons for this. The first is that corneal grafting is the province of ophthalmologists, who (with notable exceptions) are isolated from the transplant community. The second is that there is a widespread belief that, because of the existence of immune privilege, corneal grafts are not rejected and so there is no need for further research. As we will discuss later, this is incorrect. In this article we will seek to show that study of corneal transplantation is important in its own right, and also that it has lessons for those interested in other forms of allograft.