Donor and recipient therapeutic manipulations to prevent corneal allograft rejection

The outcome of corneal transplantation for dystrophic conditions such as keratoconus is excellent (1); visual results are usually good, and irreversible graft rejection, although not unknown (2), is quite uncommon. In virtually all other subsets of patients, however, corneal allograft rejection remains a major cause of graft failure (3). This point is well illustrated in Fig. 1, which shows actuarial graft survival for those patients who have received a corneal graft in our institution over the past 6 years. The actuarial 5-year graft survival rate for the subgroup with keratoconus is 96%; for the subgroup excluding keratoconus, it is 64%. For this latter group, 70% of grafts lost were considered to have failed from rejection.