Age-Related Effects of Donor on Corneal Transplantation and Clinical Study of Causal Allograft Rejection in Pakistan

Background: Corneal transplantation is a widely performed surgical procedure for treating corneal blindness. Donor-related factors, particularly age, are known to influence graft survival and rejection rates. While younger donor corneas exhibit higher endothelial cell density, their potential for increased immunogenicity remains a concern. This study evaluates the impact of donor age on corneal transplantation outcomes in Pakistan. Objective: To assess the influence of donor age on graft clarity, visual acuity, and allograft rejection rates following corneal transplantation. Methods: A retrospective observational study was conducted from February 2013 to June 2016 in collaboration with the Rawalpindi Eye Donor Organization, The Shifa Eye Trust, and Saba Deseret Eye Hospital. A total of 300 patients underwent corneal transplantation, categorized by donor age: <40 years (n=105), 40–60 years (n=120), and >60 years (n=75). Surgical techniques included Penetrating Keratoplasty (PK) (70%), Descemet’s Stripping Endothelial Keratoplasty (DSEK) (20%), and Descemet Membrane Endothelial Keratoplasty (DMEK) (10%). Postoperative outcomes were assessed at 12 months. Data were analyzed using SPSS v25, with chi-square tests for categorical variables and logistic regression for predictors of rejection. Results: At 12 months, 80% (n=240) of grafts remained clear, while 20% (n=60) developed opacity. Visual acuity improved to 20/40 or better in 85% (n=255) of patients. The overall rejection rate was 15% (n=45), highest in young donor grafts (21%), followed by middle-aged (13%) and older donor grafts (8%) (p=0.046). Patients undergoing DSEK and DMEK had significantly lower rejection rates than PK (p<0.01). Conclusion: Donor age did not significantly affect graft clarity or visual acuity but influenced rejection rates, with younger donor grafts exhibiting a higher risk. Advanced surgical techniques and postoperative steroid management improved outcomes. Future research should focus on optimizing donor selection criteria and long-term graft survival strategies.