Association of Donor and Recipient Smoking, Diabetes, and Age With Graft Failure and Rejection After Penetrating Keratoplasty.

To evaluate whether the combined donor and recipient factors of smoking, diabetes, and age have an association with graft failure and rejection after penetrating keratoplasty (PK). Data from 597 eyes of 516 patients who underwent PK at a single tertiary center between May 2007 and September 2018 were included. Donor and recipient smoking, diabetes, and age were extracted from electronic medical records. The primary outcomes were graft failure and graft rejection. Cox proportional hazards models for graft failure and rejection were generated to assess significant risk factors. The smoker donor-recipient pairing had a higher proportion of graft failures (57.6% vs. 31.5%), a higher hazard ratio (HR) for failure (1.69, 95% confidence interval [CI], 1.00-2.84), and a lower graft survival (2.85 years, 95% CI, 1.87-3.83 years vs. 4.81 years, 95% CI, 4.40-5.21 years) compared with the nonsmoker donor-recipient pairing (P < 0.05 for all). In addition, the low age donor-recipient pairing had a higher proportion of graft rejection (43.5% vs. 28.7%), a higher HR for rejection (2.11, 95% CI, 1.45-3.06), and a lower graft rejection-free survival (3.72 years, 95% CI, 3.20-4.20 years vs. 5.55 years, 95% CI, 4.97-6.13 years) compared with the high age donor-recipient pairing (P < 0.05 for all). Donor-recipient smoking was not associated with graft rejection, donor-recipient age was not associated with graft failure, and diabetic donor-recipient pairs did not yield significant associations with graft failure or rejection. Donor and recipient smoking and age could be jointly considered when counseling patients on graft outcomes.