Impact of donor-recipient gender mismatch on outcomes in Descemet membrane endothelial keratoplasty (DMEK).

PURPOSE: Previous studies have suggested that H-Y antigens may influence immunological outcomes in corneal transplantation. This study analyses the influence of donor-recipient gender mismatch in DMEK on postoperative outcomes.

METHODS

This single-center retrospective study included 2521 eyes (1712 patients) that underwent DMEK between January 2012 and December 2021. Patients were divided into four groups according to donor-to-recipient gender combinations (male-to-female, male-to-male, female-to-male, female-to-female) and were compared in terms of graft failure rate, visual acuity (VA), central corneal thickness (CCT), and endothelial cell count (ECC) preoperatively and at 1, 12 and 36 months postoperatively, as well as in terms of postoperative complications.

RESULTS

Of the 2521 cases, 1647 (65%) were sex-mismatched (male-to-female or female-to-male) and 874 (35%) were sex-matched (female-to-female or male-to-male). Intraoperative preparation time of the grafts (p = 0.78) and difficulties in the intraoperative handling (p = 0.43) were comparable in all groups. Re-bubbling or re-keratoplasty was required with comparable frequency (p = 0.84; p = 0.61 respectively). The occurence of primary or secondary graft failure was not statistically significant different between the groups (p = 0.57). No confirmed case of immunological graft rejection occurred. Functional postoperative outcomes for ECC (p = 0.18 after 1 month, p = 0.13 after 12 months, p = 0.27 after 36 months), CCT (p = 0.58 after 4-6 weeks, p = 0.82 after 12 months, p = 0.78 after 36 months) and VA (p = 0.64 after 4-6 weeks, p = 0.47 after 12 months, p = 0.39 after 36 months) were comparable in all groups at the follow-up.

CONCLUSIONS

In this retrospective cohort, no documented immune graft rejection was observed, and sex mismatch did not influence intraoperative handling or postoperative interventions. However, prospective studies with standardized immunologic assessment are needed to clarify the role of donor-recipient sex mismatch in DMEK outcomes.