Donor Age Not a Factor in Most Corneal Transplants

Corneas transplanted from a 71-year-old donor are likely to remain as healthy as a cornea from a donor half that age, according to a new study.

Researchers at the Jaeb Center for Health Research (Tampa, FL, USA) and 80 clinical sites across the United States participating in The Cornea Donor Study enrolled 1,090 people eligible for transplants, aged 40–80. The donor corneas, provided by 43 eye banks, were transplanted without respect to patient age via penetrating keratoplasty, in which the central part of the damaged cornea is removed, and a full-thickness donor cornea is sutured in its place. The main outcome of the study was to compare graft survival rates for corneas from two donor age groups aged 12–65 and 66–75.

The results of the study showed that 10-year success rates remained steady at 75% from all donors 34–71 years old; success rates were slightly higher for donors under 34 and somewhat lower for donors over 71. The researcher also found that at 10 years, corneas from donors over age 65 had a slightly higher rate of endothelial cell loss (79%) compared to those from donors age 65 and under (76%). The youngest corneas, from donors age 12–33, had the highest number of cells before surgery and the lowest rate of cell loss at 10 years (67%). The study was published online ahead of print on November 15, 2013, in Ophthalmology.

“Overall, the findings clearly demonstrate that most corneal transplants have remarkable longevity regardless of donor age,” said study coauthor Mark Mannis, MD, chair of ophthalmology at the University of California, Davis (CA, USA). “The majority of patients continued to do well after ten years, even those who received corneas from the oldest donors.”

“The Cornea Donor Study demonstrates the viability of older donor tissue in the majority of cases with endothelial disease. In time, we hope the study will have a lasting impact on the practice of corneal transplant surgery,” added Dr. Mannis. “Although the results suggest that age-matching may be appropriate for the very youngest donors and patients, we do not think it is necessary in the vast majority of cases.”

The researchers concluded that the high success rate for transplants involving donors under age 34 raises the question of whether age matching of donors and recipients is appropriate at the extremes of recipient age, a frequent practice for children and other young patients in need of corneal transplants who routinely seek corneas from young donors. Young donor corneas are relatively rare however, and in 2012, corneal donors under age 31 comprised less than 10% of the US donor pool.

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Jaeb Center for Health Research