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Gerhard Opelz - One of the best experts on this subject based on the ideXlab platform.
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kidney Graft Survival in europe and the united states strikingly different long term outcomes
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Dohler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft Survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft Survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year Survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft Survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower Graft Survival is not explained by differences in baseline patient characteristics. CONCLUSIONS: Long-term kidney Graft Survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term Graft Survival differences between Europe and the United States is a high priority for improving long-term Graft Survival.
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kidney Graft Survival in europe and the united states strikingly different long term outcomes
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Dohler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft Survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft Survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year Survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft Survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower Graft Survival is not explained by differences in baseline patient characteristics. CONCLUSIONS: Long-term kidney Graft Survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term Graft Survival differences between Europe and the United States is a high priority for improving long-term Graft Survival.
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hla matching and kidney transplantation beyond Graft Survival
Clinical Transplantation, 2013Co-Authors: Gerhard Opelz, Bernd DohlerAbstract:Analysis of data from the international Collaborative Transplant Study has revealed striking relationships between human leukocyte antigen mismatching and Graft Survival, the incidence of death from cardiovascular disease or infection, the occurrence of non-Hodgkin lymphoma, and onset of post-transplant osteoporosis and bone fracture following kidney transplantation from a deceased donor.
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influence of immunosuppressive regimens on Graft Survival and secondary outcomes after kidney transplantation
Transplantation, 2009Co-Authors: Gerhard Opelz, Bernd DohlerAbstract:BACKGROUND: There have been striking changes during the last 10 years concerning the choice of calcineurin inhibitor and antimetabolite agent prescribed after kidney transplantation. METHODS: A retrospective analysis of 51,303 patients undergoing deceased-donor kidney transplantation during 1998 to 2007 was performed using multivariate regression analysis. All patients received cyclosporine A (CsA) or tacrolimus (Tac) with azathioprine (AZA) or mycophenolic acid (MPA) on an intention-to-treat basis with corticosteroids plus/minus antibody induction. Graft Survival rates and secondary outcomes were analyzed. A subanalysis was performed for transplants undertaken during 2002 to 2007, in which all patients were treated with MPA plus corticosteroids and CsA or Tac. RESULTS: All-cause Graft failure and death-censored Graft failure to 5 years posttransplant did not differ significantly between Tac and CsA. We found no evidence in support of previous claims that MPA results in superior long-term Graft Survival compared with AZA treatment. At the end of year 1, Tac was associated with a lower risk for serum creatinine more than or equal to 130 mumol/L (P<0.001) and hypercholesterolemia (P<0.001) versus CsA, but a higher risk for de novo posttransplant diabetes (P<0.001). MPA treatment was associated with a lower risk of acute rejection (P<0.001) but a higher risk of hospitalization because of infection (P<0.001) versus AZA. CONCLUSIONS: Five-year Graft Survival in deceased-donor kidney transplant recipients is equivalent in patients receiving CsA- or Tac-based immunosuppression, and in those receiving MPA or AZA. The absence of a Survival benefit with modern agents is relevant in the current cost-conscious era of prescribing.
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influence of time of rejection on long term Graft Survival in renal transplantation
Transplantation, 2008Co-Authors: Gerhard Opelz, Bernd DohlerAbstract:Background. The aim of this analysis was to investigate the relationship of acute rejection episodes (ARE) at different times posttransplantation with reversibility of Graft dysfunction and long-term Graft failure using data from the Collaborative Transplant Study database. Methods. A total of 28,867 patients receiving their Graft between 1995 and 2005 from deceased donors were included in the analysis. The time from renal transplantation to first treated ARE was divided into intervals up to 3 years. Long-term Graft Survival and half-life rates were calculated and hazard ratios (HR) for failure were computed using multivariate Cox regression analysis. Results. Compared with patients who did not receive rejection treatment during the first posttransplant year, HR for Graft Survival increased to 1.35 for patients with rejection 0 to 90 days (P<0.001), 2.05 with rejection 91 to 180 days (P<0.001), and 2.74 with rejection 181 to 365 days of posttransplantion (P<0.001). First rejections occurring during the second year were associated with HR 3.35 (P<0.001) and rejections during the third year with HR 3.17 (P<0.001). In addition to the time of rejection, the degree of functional recovery after rejection treatment was found to be important for subsequent Graft Survival. Conclusion. The time point of occurrence and the degree of functional recovery after rejection treatment were found to significantly influence the impact of ARE on long-term Graft Survival, and we were able to quantify the associated risks.
Bernd Dohler - One of the best experts on this subject based on the ideXlab platform.
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analyses of the short and long term Graft Survival after kidney transplantation in europe between 1986 and 2015
Kidney International, 2018Co-Authors: Maarten Coemans, Bernd Dohler, Dirk Kuypers, Caner Susal, D Anglicheau, Magali Giral, Oriol Bestard, Christophe Legendre, Mariepaule Emonds, Geert MolenberghsAbstract:The evolution of kidney alloGraft Survival remains insufficiently studied in the context of the changing donor and recipient demographics. Since European data are lacking we performed a cohort study (1986-2015) that, based on the Collaborative Transplant Study, included 108 787 recipients of brain-death kidney donors in 135 hospitals across 21 European countries. We analyzed the hazard rate of kidney failure after transplantation. Between 1986 and 1999, improvement in Graft Survival was more pronounced in the short term than in the long term: one-, five- and ten-year hazard rates after transplantation declined 64% (95% confidence interval, 61%–66%), 53% (49%–57%) and 45% (39%–50%), respectively. Between 2000 and 2015, hazard rates at one, five and ten years post-transplant declined respectively 22% (12–30%), 47% (36–56%) and 64% (45–76%). Improvement in Graft Survival in the first five years post-transplant was significantly less since 2000, while improvement after five years was comparable to before. During the 2000-2015 period improvement of Graft Survival was greater in the long than in the short term. These changes were independent of changing donor and recipient characteristics, and reflect the evolution in global kidney transplant management over the past decades. Unfortunately, after accounting for the evolution of donor and recipient characteristics, we found that short-term improvement in Graft Survival decreased since 2000, while long-term improvement remained unchanged in Europe. Thus, deceleration of short-term Graft Survival improvement in more recent years illustrates an unmet need for innovation.
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kidney Graft Survival in europe and the united states strikingly different long term outcomes
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Dohler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft Survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft Survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year Survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft Survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower Graft Survival is not explained by differences in baseline patient characteristics. CONCLUSIONS: Long-term kidney Graft Survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term Graft Survival differences between Europe and the United States is a high priority for improving long-term Graft Survival.
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kidney Graft Survival in europe and the united states strikingly different long term outcomes
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Dohler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft Survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft Survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year Survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft Survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower Graft Survival is not explained by differences in baseline patient characteristics. CONCLUSIONS: Long-term kidney Graft Survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term Graft Survival differences between Europe and the United States is a high priority for improving long-term Graft Survival.
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hla matching and kidney transplantation beyond Graft Survival
Clinical Transplantation, 2013Co-Authors: Gerhard Opelz, Bernd DohlerAbstract:Analysis of data from the international Collaborative Transplant Study has revealed striking relationships between human leukocyte antigen mismatching and Graft Survival, the incidence of death from cardiovascular disease or infection, the occurrence of non-Hodgkin lymphoma, and onset of post-transplant osteoporosis and bone fracture following kidney transplantation from a deceased donor.
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influence of immunosuppressive regimens on Graft Survival and secondary outcomes after kidney transplantation
Transplantation, 2009Co-Authors: Gerhard Opelz, Bernd DohlerAbstract:BACKGROUND: There have been striking changes during the last 10 years concerning the choice of calcineurin inhibitor and antimetabolite agent prescribed after kidney transplantation. METHODS: A retrospective analysis of 51,303 patients undergoing deceased-donor kidney transplantation during 1998 to 2007 was performed using multivariate regression analysis. All patients received cyclosporine A (CsA) or tacrolimus (Tac) with azathioprine (AZA) or mycophenolic acid (MPA) on an intention-to-treat basis with corticosteroids plus/minus antibody induction. Graft Survival rates and secondary outcomes were analyzed. A subanalysis was performed for transplants undertaken during 2002 to 2007, in which all patients were treated with MPA plus corticosteroids and CsA or Tac. RESULTS: All-cause Graft failure and death-censored Graft failure to 5 years posttransplant did not differ significantly between Tac and CsA. We found no evidence in support of previous claims that MPA results in superior long-term Graft Survival compared with AZA treatment. At the end of year 1, Tac was associated with a lower risk for serum creatinine more than or equal to 130 mumol/L (P<0.001) and hypercholesterolemia (P<0.001) versus CsA, but a higher risk for de novo posttransplant diabetes (P<0.001). MPA treatment was associated with a lower risk of acute rejection (P<0.001) but a higher risk of hospitalization because of infection (P<0.001) versus AZA. CONCLUSIONS: Five-year Graft Survival in deceased-donor kidney transplant recipients is equivalent in patients receiving CsA- or Tac-based immunosuppression, and in those receiving MPA or AZA. The absence of a Survival benefit with modern agents is relevant in the current cost-conscious era of prescribing.
Francis W Price - One of the best experts on this subject based on the ideXlab platform.
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descemet s stripping endothelial keratoplasty long term Graft Survival and risk factors for failure in eyes with preexisting glaucoma
Ophthalmology, 2012Co-Authors: Arundhati Anshu, Marianne O Price, Francis W PriceAbstract:Purpose To evaluate long-term corneal Graft Survival and risk factors for Graft failure after Descemet's stripping endothelial keratoplasty (DSEK) in eyes with preexisting glaucoma. Design Retrospective case control study. Participants A total of 835 DSEK cases performed by a single surgeon between December 2003 and August 2007 were reviewed. Only the first treated eye of each patient with at least 1 year follow-up was included, resulting in 453 cases; 342 had no prior glaucoma (C), 65 had medically managed preexisting glaucoma (G), and 46 had prior glaucoma surgery (GS). Methods Corneal Graft failure was defined as persistent corneal edema resulting in irreversible loss of optical clarity. Corneal Graft Survival in the 3 groups was calculated using Kaplan–Meier Survival analysis. Nine potential risk factors for Graft failure were evaluated by Cox proportional hazards univariate and multivariate analysis. These methods took length of follow-up into consideration. Main Outcome Measures Corneal Graft Survival and risk factors influencing long-term corneal endothelial failure. Results The 1-, 2-, 3-, 4-, and 5-year Graft Survival was 99%, 99%, 97%, 97%, and 96%, respectively, in group C; 100%, 98%, 98%, 96%, and 90%, respectively, in group G; and 96%, 91%, 84%, 69%, and 48%, respectively, in group GS ( P P Conclusions Patients with medically managed glaucoma had significantly better 5-year Graft Survival than those with surgically managed glaucoma. A prior glaucoma shunt or trabeculectomy significantly increased the risk of DSEK endothelial failure. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
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descemet s stripping endothelial keratoplasty under failed penetrating keratoplasty visual rehabilitation and Graft Survival rate
Ophthalmology, 2011Co-Authors: Arundhati Anshu, Marianne O Price, Francis W PriceAbstract:Purpose To evaluate Graft Survival, risk factors for failure, complications, and visual rehabilitation in patients who underwent Descemet's stripping endothelial keratoplasty (DSEK) under a failed penetrating keratoplasty (PK). Design Retrospective interventional case series. Participants Sixty eyes (60 patients) treated at Price Vision Group, Indianapolis, Indiana. Methods Graft diameters ranged from 8 to 9 mm and were ∼1 mm larger than the previous PK. The Descemet's membrane was not stripped in the majority (54, 84%). The Graft was inserted using forceps or a Busin funnel glide (Moria, Anthony, France). The probability of Graft Survival was calculated by Kaplan–Meier Survival analysis. Main Outcome Measures Graft Survival, best-corrected visual acuity (BCVA), and complications. Results The mean recipient age was 68 years (range, 17–95 years). Forty eyes had 1 previous failed PK, 14 eyes had 2 previous failed PKs, and 6 eyes had 3 previous failed PKs. Thirty-one eyes (52%) had preexisting glaucoma, and 16 eyes (27%) had prior glaucoma surgery (trabeculectomy in 4, shunt procedure in 12). Fifty-five Grafts were performed for visual rehabilitation, and 5 Grafts were performed for pain relief. Median follow-up was 2.3 years (range, 2 months to 6 years). Median preoperative BCVA was 1.23 logarithm of the minimum angle of resolution (logMAR) (range, 0.2–3, Snellen 20/340), and median postoperative visual improvement was 0.6 logMAR (6 lines), range −0.3 to +2.7. Four eyes had Graft detachment (6.6%), 7 eyes (10.5%) had endothelial rejection, and 10 eyes (16.6%) had Graft failure (primary failure in 2, secondary failure in 8). The overall secondary Graft Survival rates were 98%, 90%, 81%, and 74% at 1, 2, 3, and 4 years, respectively. Prior glaucoma shunt was the principal risk factor for Graft failure. The Graft Survival rates were 100%, 96%, 96%, and 96% in eyes without a prior shunt versus 93%, 74%, 44%, and 22% with a prior shunt at 1, 2, 3, and 4 years, respectively ( P =0.0005; relative risk=20). Peripheral anterior synechiae ( P =0.14), neovascularization ( P =0.88), endothelial rejection ( P =0.59), and number of prior PKs ( P =0.13) were not independent risk factors for Graft failure. Conclusions Endothelial keratoplasty under a previous failed PK is a useful alternative to a repeat standard PK, particularly in eyes with an acceptable topography and refractive outcome before failure. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
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descemet s stripping endothelial keratoplasty five year Graft Survival and endothelial cell loss
Ophthalmology, 2011Co-Authors: Marianne O Price, Kelly M Fairchild, David A Price, Francis W PriceAbstract:Purpose To assess 5-year Descemet's stripping endothelial keratoplasty (DSEK) Graft Survival and endothelial cell loss in the surviving Grafts. Design Retrospective, interventional case series. Participants One hundred sixty-five eyes of 149 patients treated with primary DSEK. Methods Donor corneal–scleral rims were dissected manually or with a microkeratome and were cut with a trephine. The Graft was folded endothelial side inward and was inserted with forceps through a 5-mm incision. The cumulative probability of secondary Graft failure was calculated using Kaplan-Meier Survival analysis and the log-rank test. Endothelial cell density (ECD) was determined from baseline preoperative donor and 1-year, 3-year, and 5-year postoperative central endothelial images. Main Outcome Measures Graft Survival and ECD at 5 years. Results The median recipient age was 71 years (range, 22–90 years) and 62% were female. Eighteen eyes (11%) were treated for pseudophakic or aphakic corneal edema and 147 eyes (89%) were treated for Fuchs' dystrophy. The cumulative 5-year Survival rate was significantly lower in pseudophakic or aphakic corneal edema eyes (76%) versus Fuchs' eyes (95%; P = 0.0087). In particular, the 5-year Survival rate was reduced significantly in eyes with prior glaucoma shunt or trabeculectomy surgery vs. those without (40% vs. 95%; P r = 0.22 and P = 0.04) and was not significantly correlated with recipient gender ( P = 0.075), age ( P = 0.85), or diagnosis ( P = 0.78). Conclusions The 5-year Graft Survival rates for DSEK were similar to those reported for penetrating keratoplasty in the multicenter Cornea Donor Study (95% vs. 93% for Fuchs' dystrophy and 76% vs. 73% for pseudophakic or aphakic corneal edema). Furthermore, the 5-year endothelial cell loss after DSEK compared favorably with that measured after penetrating keratoplasty in the Cornea Donor Study (53% vs. 70%). Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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long term Graft Survival after penetrating keratoplasty
Ophthalmology, 2003Co-Authors: Robert W Thompson, Marianne O Price, Patrick J Bowers, Francis W PriceAbstract:Abstract Purpose To determine long-term Graft Survival rates and causes of secondary Graft failures for a large series of penetrating keratoplasties (PKPs). Design Retrospective, noncomparative case series. Participants Longitudinal review of 3992 consecutive eyes that underwent PKP at a large tertiary care referral center from 1982 through 1996. Data were collected retrospectively from August 1982 through December 1988 and prospectively thereafter. Intervention Three thousand six hundred forty primary Grafts and 352 reGrafts. Main outcome measures Corneal Graft Survival and etiology of Graft failures. Patients were evaluated preoperatively and at 1, 3, 6, 9, 12, 18, and 24 months after transplant, then at yearly intervals. Results Mean recipient age was 67 years (range, 1–98 years). The predominant indications for PKP were pseudophakic bullous keratopathy (32%) and Fuchs' dystrophy (23%). Graft failure occurred in 10% (385) of the eyes. The most common causes of secondary Graft failure were endothelial failure (29%) or immunologic endothelial rejection (27%). Survival of first time Grafts was 90% at 5 years and 82% at 10 years. Initial reGrafts had significantly lower 5-year and 10-year Survival rates, 53% and 41%, respectively. The highest 5-year and 10-year Survival rates were noted in primary Grafts for eyes with a preoperative diagnosis of keratoconus (97% and 92%, respectively), or Fuchs' dystrophy (97% and 90%, respectively). Primary Grafts for aphakic bullous keratopathy without intraocular lens placement had the lowest 5-year Survival rate, 70%. Conclusions The 5-year and 10-year Survival rates in this series demonstrate that PKP is a safe and effective treatment for the corneal diseases commonly transplanted in the United States. However, endothelial failure and immunologic Graft rejection were persistent risks over the long term, supporting the need for continued patient follow-up. ReGrafts, aphakic eyes without intraocular lens placement at the time of transplant, and corneas with deep stromal vascularization had reduced Graft Survival rates. Pseudophakic bullous keratopathy Grafts with a retained posterior chamber intraocular lens were at increased risk of endothelial failure compared with primary Grafts done for other causes or compared with pseudophakic bullous keratopathy Grafts done with intraocular lens exchange.
Jodhbir S Mehta - One of the best experts on this subject based on the ideXlab platform.
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five year Graft Survival comparing descemet stripping automated endothelial keratoplasty and penetrating keratoplasty
Ophthalmology, 2016Co-Authors: Hla Myint Htoon, Jodhbir S MehtaAbstract:Purpose To compare 5-year Graft Survival after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in Asian eyes. Design Prospective, nested, cohort study. Participants Consecutive patients who underwent DSAEK (423 eyes) or PK (405 eyes) for Fuchs' endothelial dystrophy (FED) or bullous keratopathy (BK). Methods Clinical data and donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Registry. All surgeries were performed by the corneal surgeons at our center, which included cases performed or partially performed by corneal fellows in training under direct supervision. Main Outcome Measures Five-year cumulative Graft Survival. Results Overall mean age was 67.8±9.8 years, and 50.1% of patients were men. There were no significant differences in age ( P = 0.261) or gender ( P = 0.78) between PK and DSAEK groups in our predominantly Chinese (76.6%) Asian cohort, with more BK compared with FED (68.1% vs. 31.9%; P P P = 0.007). Cox regression analysis revealed that BK was a significant factor associated with Graft failure (hazard ratio [HR], 3.30; 95% confidence interval [CI], 2.05–5.33; P P = 0.02) adjusting for confounders such as recipient age, gender, and donor factors. Five-year cumulative incidence of complications such as Graft rejection ( P P P P = 0.002) were greater in the PK group compared with the DSAEK group. Conclusions In Asian eyes from the same study cohort with standardized surgical and postoperative regimes, 5-year Graft Survival was superior for DSAEK compared with PK in eyes with FED and BK.
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endothelial cell loss and Graft Survival after descemet s stripping automated endothelial keratoplasty and penetrating keratoplasty
Ophthalmology, 2012Co-Authors: Jodhbir S Mehta, Saideep Bose, Hla Myint HtoonAbstract:Purpose We sought to compare endothelial cell (EC) loss and Graft Survival after Descemet's stripping automated endothelial keratoplasty (DSAEK) and conventional penetrating keratoplasty (PK) in Asian eyes. Design Retrospective, nested, cohort study. Participants Consecutive patients who underwent DSAEK or PK with Fuchs' endothelial dystrophy or pseudophakic and aphakic bullous keratopathy (BK) at a single tertiary center from April 1, 2006, to April 1, 2008. Methods Clinical data, and donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Study. Main Outcome Measures Percent EC loss and Graft Survival up to 3 years. Results There were no differences in baseline characteristics of patients comparing DSAEK and PK; there were more patients with BK (n = 141, 68.4%) than Fuchs' dystrophy. Percent EC loss was lower in DSAEK compared with PK at 1 (30±22% vs 37±25%; P = 0.045), 2 (36±23% vs 45±33%; P = 0.018), and 3 years (39±24% vs 47±28%; P = 0.022) postoperatively. Graft Survival was comparable (log-rank P = 0.671) between DSAEK and PK at 1 (94% vs 90%), 2 (88% vs 85%), and 3 years (87% vs 85%). Conclusions Compared with PK, DSAEK resulted in lower EC loss with comparable cumulative Graft Survival rates for up to 3 years in patients with Fuchs' dystrophy and BK. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Hla Myint Htoon - One of the best experts on this subject based on the ideXlab platform.
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five year Graft Survival comparing descemet stripping automated endothelial keratoplasty and penetrating keratoplasty
Ophthalmology, 2016Co-Authors: Hla Myint Htoon, Jodhbir S MehtaAbstract:Purpose To compare 5-year Graft Survival after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in Asian eyes. Design Prospective, nested, cohort study. Participants Consecutive patients who underwent DSAEK (423 eyes) or PK (405 eyes) for Fuchs' endothelial dystrophy (FED) or bullous keratopathy (BK). Methods Clinical data and donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Registry. All surgeries were performed by the corneal surgeons at our center, which included cases performed or partially performed by corneal fellows in training under direct supervision. Main Outcome Measures Five-year cumulative Graft Survival. Results Overall mean age was 67.8±9.8 years, and 50.1% of patients were men. There were no significant differences in age ( P = 0.261) or gender ( P = 0.78) between PK and DSAEK groups in our predominantly Chinese (76.6%) Asian cohort, with more BK compared with FED (68.1% vs. 31.9%; P P P = 0.007). Cox regression analysis revealed that BK was a significant factor associated with Graft failure (hazard ratio [HR], 3.30; 95% confidence interval [CI], 2.05–5.33; P P = 0.02) adjusting for confounders such as recipient age, gender, and donor factors. Five-year cumulative incidence of complications such as Graft rejection ( P P P P = 0.002) were greater in the PK group compared with the DSAEK group. Conclusions In Asian eyes from the same study cohort with standardized surgical and postoperative regimes, 5-year Graft Survival was superior for DSAEK compared with PK in eyes with FED and BK.
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endothelial cell loss and Graft Survival after descemet s stripping automated endothelial keratoplasty and penetrating keratoplasty
Ophthalmology, 2012Co-Authors: Jodhbir S Mehta, Saideep Bose, Hla Myint HtoonAbstract:Purpose We sought to compare endothelial cell (EC) loss and Graft Survival after Descemet's stripping automated endothelial keratoplasty (DSAEK) and conventional penetrating keratoplasty (PK) in Asian eyes. Design Retrospective, nested, cohort study. Participants Consecutive patients who underwent DSAEK or PK with Fuchs' endothelial dystrophy or pseudophakic and aphakic bullous keratopathy (BK) at a single tertiary center from April 1, 2006, to April 1, 2008. Methods Clinical data, and donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Study. Main Outcome Measures Percent EC loss and Graft Survival up to 3 years. Results There were no differences in baseline characteristics of patients comparing DSAEK and PK; there were more patients with BK (n = 141, 68.4%) than Fuchs' dystrophy. Percent EC loss was lower in DSAEK compared with PK at 1 (30±22% vs 37±25%; P = 0.045), 2 (36±23% vs 45±33%; P = 0.018), and 3 years (39±24% vs 47±28%; P = 0.022) postoperatively. Graft Survival was comparable (log-rank P = 0.671) between DSAEK and PK at 1 (94% vs 90%), 2 (88% vs 85%), and 3 years (87% vs 85%). Conclusions Compared with PK, DSAEK resulted in lower EC loss with comparable cumulative Graft Survival rates for up to 3 years in patients with Fuchs' dystrophy and BK. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
