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We Pursue Eye Research

Corneal Transplants

Cornea Transplant Rejection

Corneal transplants are the most successful of all solid organ transplants and the eye medications we use significantly increase the likelihood of a successful result. However, as with heart and kidney transplants, rejection of the donor tissue can sometimes occur. About 1 out of 4 cornea transplant recipients experiences a graft rejection episode. If cornea transplant rejection episode is detected early, it can be reversed 9 out of 10 times using medication, and damage to the new cornea can be minimized. Rejection that results in permanent clouding of the cornea transplant occurs in less than 5% of our cases. If the cornea transplant becomes cloudy due to rejection, it can usually be replaced with a new cornea. Unfortunately, the likelihood of success is less after a graft is replaced.

When does rejection happen?
  • Most rejection episodes occur in the first year after the transplant, but sometimes a rejection episode may occur many years later, so it is important to always be vigilant for the signs of rejection.
  • Sometimes having the flu or getting a vaccination or blood transfusion can activate the immune system and trigger a transplant rejection episode. Don’t let concerns about this prevent you from getting vaccinations or necessary medical treatment. When getting a vaccination, you should use prednisolone acetate eye drops (Pred Forte) 4 times a day in the grafted eye for 2 days before and for 2 weeks following the vaccination to reduce the risk of rejection.  If you have a history of viral infection or other eye infection that prompted your initial transplant, please check with your transplant surgeon for eye drop recommendations before your vaccination.
What are the signs of rejection? (think RSVP)
  • Redness: graft rejection may be associated with eye redness
  • Sensitivity: rejection may cause increased sensitivity to light
  • Vision: rejection can cause decreased vision, particularly foggy or cloudy vision
  • Pain: rejection can cause discomfort, irritation or foreign body sensation

You should call your doctor immediately if you notice any of these possible signs of rejection. 

Our Publications on Cornea Transplant Rejection

Our database on over 5000 cornea transplant procedures has allowed us to determine when rejection episodes are most likely to occur and who may be at increased risk of experiencing graft rejection or graft failure. We have shared this information with eye doctors around the world through the following publications in peer-reviewed scientific journals:

  1. Price MO, Jordan CS, Moore G, Price FW. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part two: the statistical analysis of probability and risk factors. Br J Ophthalmology 2009;93:391-5.
  2. Jordan CS, Price MO, Trespalacios R, Price FW. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms. Br J Ophthalmol 2009;93:387-09.
  3. Allan B, Terry MA, Price FW, Price MO, Griffin N, Claesson M. Corneal transplant rejection rate and severity after endothelial keratoplasty. Cornea 2007; 26:1039-42.
  4. Price MO, Thompson RW, Price FW. Risk factors for various causes of failure in initial corneal grafts. Archives of Ophthalmology, 2003; 121:1087-1092.
  5. Thompson RW, Price MO, Bowers PJ, Price FW. Long-term graft survival after penetrating keratoplasty. Ophthalmology, 2003; 121:1087-1092
  6. Price FW, Whitson WE, Johns SK, Gonzales JS. Risk factors for corneal graft failure. J Refract Surg 1996;12:133-146.
  7. Price FW, Whitson WE, Collins KS. Five-year corneal graft survival. A large, single-center patient cohort. Arch Ophthalmol 1993;111:799-805.
  8. Price FW, Whitson WE. Graft survival in four common groups of patients undergoing penetrating keratoplasty. Ophthalmology 1991;98:322-328.