Why do corneal transplants have minimal risk of rejection?


For straightforward or “low-risk” cornea transplants (PKP) with local immune control, about 95% of grafts last for 5 years. This high success is because the cornea is naturally protected from immune reactions for several reasons:

  • It doesn’t have blood vessels, so immune cells can’t easily reach it.
  • It lacks channels that would carry harmful substances to immune cells.
  • It has proteins that can make certain immune cells die.
  • It shows fewer signs that could trigger immune reactions.
  • It has special substances that calm down immune responses.

However, for “high-risk” patients with a blood supply to the cornea, the failure rate can go up to 35% in three years. Even though the cornea is somewhat protected from immune reactions, the main reason transplants fail is because of irreversible immune rejection.

Deep anterior lamellar keratoplasty (DALK) has an edge over PKP because it lowers the chance of rejection, although there can still be other types of rejection. Newer methods like DSEK and DMEK have improved cornea transplants by using less foreign tissue, reducing rejection risks.

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