Infectious disease risk factors of corneal graft donors.

Objective: To determine how donor health status affects the risk of infection after corneal transplant.

Methods: An adverse reaction surveillance registry was used to conduct a matched case-control study among transplanted donor corneas from January 1, 1994, to December 31, 2003. Cases comprised 162 reports of endophthalmitis after penetrating keratoplasty including 121 with microbial recovery, of which 59 had concordant donor and recipient microbial isolates. Two controls were matched to each case by surgery date. Conditional logistic regression estimated adjusted odds ratios with 95% confidence intervals according to the premortem status of decedent donors.

Results: Postkeratoplasty endophthalmitis was associated with recent hospitalization (odds ratio, 2.84; 95% confidence interval, 1.61-4.98) and fatal cancer (odds ratio, 2.46; 95% confidence interval, 1.53-3.97) among donors. Endophthalmitis appeared more likely with tissues transplanted longer than 5 days after donation (odds ratio, 1.55; 95% confidence interval, 1.02-2.35). The prevalence of concordant microbial isolates from donors and recipients was greater among fungal endophthalmitis than among bacterial endophthalmitis (P < .001).

Conclusions: Corneal grafts with eye tissue obtained from donors dying in the hospital or with cancer may have an increased risk of postsurgical endophthalmitis, possibly due to donor-to-host microbial transmission. Together with donor screening and processing, improvements in microbiological control may reduce infection associated with corneal transplant.