Ocular Inflammation in Solid Organ Transplant Patients Receiving Maintenance Immunosuppression

PURPOSE: Patients are maintained on lifelong immunomodulatory therapy (IMT) after organ transplantation; however, new inflammatory conditions have developed in transplant recipients despite systemic immunosuppression. A prior study reported uveitis in transplant patients on IMT but did not describe clinical courses. We report the first case series describing nine cases of presumed non-infectious uveitis/scleritis in transplant recipients on IMT. METHODS: Patients with a history of a solid organ transplantation who were diagnosed with uveitis and/or scleritis from June 2014 to June 2026 were identified. Inclusion required transplantation prior to uveitis/scleritis occurrence and ongoing IMT. Cases with a history of uveitis/scleritis prior to transplant, trauma/surgery, infection, or a history of autoimmune conditions causing uveitis were excluded. Nine cases met the criteria, and clinical characteristics-including transplant history and ocular disease course-were abstracted. RESULTS: = 2) transplants, were included. The mean age was 46.9 years; patients developed uveitis or scleritis a median of 4 years after the most recent transplant. All patients were treated with topical or oral corticosteroids at a minimum. Six patients had a single episode of ocular inflammation, and three patients had recurrences. All episodes were corticosteroid responsive. CONCLUSION: This case series describes presumed non-infectious ocular inflammation in solid organ transplant recipients receiving IMT, supporting a possibility of a broader pattern of post-transplant immune dysregulation. While patients in this series had steroid-responsive ocular inflammation, this phenomenon warrants further investigation to clarify mechanisms underlying new inflammation despite systemic immunosuppression, particularly because IMT agents are often employed in treating chronic uveitis.