Ophthalmology science · 2026
Differential Effects of T-Cell Inhibitors and Antimetabolites on Graft Survival in High-Risk Penetrating Keratoplasty: A Tertiary Center Experience.
СтатьяНазвание и аннотация: Перевод в очереди
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Chokesuwattanaskul Susama, Somkijrungroj Thanapong, Xiong Fanxiu, Gonzales John A, Satitpitakul Vannarut
Аннотация
OBJECTIVE: To evaluate the comparative effectiveness of T-cell inhibitors versus antimetabolites on graft survival in high-risk penetrating keratoplasty (PKP), with a particular focus on cases of repeat grafting.
DESIGN: Retrospective cohort study.
PARTICIPANTS: All high-risk eyes undergoing optical PKP between 2015 and 2022 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
METHODS: The medical records of 293 high-risk eyes undergoing optical PKP were reviewed. The use of any systemic steroid-sparing immunosuppressive (IS) agents was identified. In practice, all patients received either T-cell inhibitors or antimetabolites. Multivariable Cox proportional hazard models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the effect of systemic IS therapies on time to graft failure in high-risk PKP, adjusting for demographics, indications for PKP, and possible risk factors of graft failure.
MAIN OUTCOME MEASURES: Time to graft failure in high-risk PKP.
RESULTS: Among 281 high-risk eyes undergoing PKP, 217 received no IS medications, whereas 64 received IS medications (31 T-cell inhibitors, 49 antimetabolites). Notably, all eyes received topical corticosteroid immediately postoperation. In the multivariable Cox regression analysis adjusted for influential risk factors for graft failure, using any systemic IS was associated with a reduced risk of graft failure (HR: 0.71, 95% CI: 0.42-1.18), though not statistically significant. In subgroup analysis, T-cell inhibitors statistically significantly reduced the risk of graft failure (HR: 0.48, 95% CI: 0.24-0.95), whereas antimetabolites did not (HR: 0.97, 95% CI: 0.58-1.63). Among eyes with 2 or more previous grafts, IS use demonstrated a protective effect on graft failure (HR: 0.51, 95% CI: 0.28-0.94), but no benefit was observed for first-time grafts.
CONCLUSIONS: Among IS medications for high-risk PKP, T-cell inhibitors, in addition to topical corticosteroid, significantly improved graft survival, whereas antimetabolites showed no benefit. The protective effect was most pronounced in repeat transplantation, suggesting T-cell inhibitors should be preferentially considered for eyes undergoing multiple grafts.
FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.
DESIGN: Retrospective cohort study.
PARTICIPANTS: All high-risk eyes undergoing optical PKP between 2015 and 2022 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
METHODS: The medical records of 293 high-risk eyes undergoing optical PKP were reviewed. The use of any systemic steroid-sparing immunosuppressive (IS) agents was identified. In practice, all patients received either T-cell inhibitors or antimetabolites. Multivariable Cox proportional hazard models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the effect of systemic IS therapies on time to graft failure in high-risk PKP, adjusting for demographics, indications for PKP, and possible risk factors of graft failure.
MAIN OUTCOME MEASURES: Time to graft failure in high-risk PKP.
RESULTS: Among 281 high-risk eyes undergoing PKP, 217 received no IS medications, whereas 64 received IS medications (31 T-cell inhibitors, 49 antimetabolites). Notably, all eyes received topical corticosteroid immediately postoperation. In the multivariable Cox regression analysis adjusted for influential risk factors for graft failure, using any systemic IS was associated with a reduced risk of graft failure (HR: 0.71, 95% CI: 0.42-1.18), though not statistically significant. In subgroup analysis, T-cell inhibitors statistically significantly reduced the risk of graft failure (HR: 0.48, 95% CI: 0.24-0.95), whereas antimetabolites did not (HR: 0.97, 95% CI: 0.58-1.63). Among eyes with 2 or more previous grafts, IS use demonstrated a protective effect on graft failure (HR: 0.51, 95% CI: 0.28-0.94), but no benefit was observed for first-time grafts.
CONCLUSIONS: Among IS medications for high-risk PKP, T-cell inhibitors, in addition to topical corticosteroid, significantly improved graft survival, whereas antimetabolites showed no benefit. The protective effect was most pronounced in repeat transplantation, suggesting T-cell inhibitors should be preferentially considered for eyes undergoing multiple grafts.
FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.