Best Survival of Corneal Retransplantation Using Systemic Immunossupression
In all domains of organ transplantation, retransplants are a major immunological concern. First corneal grafts are usually not rejected, but further grafts show the same rate of rejection than solid organs. In our experience 50% of corneal retransplants have never attained good function. With the aim to improve corneal retransplants survival and function, 18 patients received a corneal retransplant using immunossupression. Ten patients were female, median age was 58 years old (ranging from 25 to 81 years old), the majority received a secondary graft. Thirteen received triple therapy (cyclosporin A: 5 mg/kg/day; azathioprine: 2 mg/kg/day; prednisone: 1 mg/kg/day, as initial doses from the day of grafting), and 5 received no prednisone because of concurrent diseases or advanced age. Severe clinical assessment, performed before surgery, and a frequent clinical surveillance posttransplantation avoided major complications. Reactivity against T lymphocytes was tested by a panel reactivity assay (PRA) in 8 patients and was positive in only one (13% of reactivity). One year follow-up shows 77% of patients with good function and no rejection. Fifteen percent of them lost the graft because of non-immunological problems, mainly glaucoma. Only 1 patient has lost the graft because of rejection, probably due to non-compliance. One patient presented one episode of hypertensive emergency and hypervolemia, due to the unintentional association of cyclosporine and a non-steroid anti-inflammatory drug, promptly reversed with the withdrawal of the second one. There was one bacterial pneumonic process in a diabetic patient, one episode of gastritis, one Herpes zoster infection and 2 mild rises in liver enzymes.