Current clinician's opinions on risk factors in corneal grafting. Results of a survey among surgeons in the eurotransplant area

During 1992 a questionnaire was sent to 57 cornea transplant centers in the Eurotransplant area, i.e., the Netherlands, Germany, Belgium, and Austria. Questions included the number of grafts transplanted in each center in 1991, the indications for cornea transplants, and surgeons' opinions on risk factors and indications for human leukocyte antigen (HLA)-matched grafts. A response rate of 89% (51 of 57) was achieved. The total number of grafts in the 51 reporting centers was 2,156 [average 42 (range: 3-303)]. In 19.3% of the cases HLA-matched donor tissue was used (range: 0-64%). Matched transplants were performed in high-risk cases. The term high-risk is not standardized by any means. Foremost, HLA-matched donor corneas were requested for regraft after immunologic failure of a previous transplant and in cases showing more than two quadrants of deep stromal vascularization. This survey has shown important differences in management of high-risk cases: variance in indications for HLA-matched grafting and no consistency in the weighing of the importance of HLA-A, HLA-B, and HLA-DR antigens nor consistency in the use of information on circulating antibodies. For proper allocation of available donor tissue for corneal transplants in the Eurotransplant area, a mutually accepted protocol defining indications for matched grafting is needed.