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PubMed · 9834893

[Plea for a graft].

Abstract

With the promulgation of the "Bioethics" laws in 1994 in France, the Etablissement français des Greffes was endowed with the task of defining the principles controlling human tissue grafts in France. These laws require a precise control of all material and human input involved in each step of the grafting process. Organ removal from human cadavers by the ophthalmologist, graft preservation, validation of organ banks and recipient grafting by the surgeon are some of the many steps which must follow precise rules of good practices. All those who participate in these activities from organ removal to recipient grafting must comply with these rules to obtain the necessary administrative authorization. As the "Bioethics" laws will be re-evaluated in 1999, now is the time to propose possible alternatives aimed at increasing organ procurement and shortening patient waiting lists.

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BibTeXRIS

J P Boitte, C Bouat. 1998. [Plea for a graft].. https://pubmed.ncbi.nlm.nih.gov/9834893/

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How effective is penetrating corneal transplantation? Factors influencing long-term outcome in multivariate analysis.

BACKGROUND: In a large patient cohort, we investigated long-term corneal graft outcome, risk factors for graft failure, and whether corneal graft survival had improved over time. METHODS: Records of 10,952 full-thickness corneal grafts with associated archival follow-up were examined within a prospectively-maintained, national database of 13,831 records, with follow-up extending for up to 18 years. Kaplan-Meier survival analysis was used to indicate variables of interest for Cox proportional hazards regression analysis. A model clustered by individual patient to control for inter-eye or inter-graft dependence was constructed to identify variables best predicting penetrating corneal graft failure. RESULTS: Probability of corneal graft survival was 0.86 at 1 year, 0.73 at 5 years, 0.62 at 10 years, and 0.55 at 15 years. Graft survival did not improve over a 15-year timeframe. Variables predicting graft failure in multivariate analysis included transplant centre, donor age, preoperative diagnosis, number of previous ipsilateral grafts, lens status, history of corneal neovascularisation, ocular inflammation or raised intraocular pressure in the grafted eye, requirement for anterior vitrectomy, graft size, early suture removal, postoperative events including graft neovascularisation, rise in intraocular pressure, and rejection episodes, type of treatment for raised intraocular pressure, and arrangements for recipient follow-up. A further 11 variables showing a significant influence on graft survival in univariate analysis were not included in the final Cox model. CONCLUSION: The long-term results of corneal transplantation are no better than for other forms of transplantation and have shown no measurable improvement over the past 15 years.

Corneal Transplantation↗