Systematic EDP-supported acquisition of follow-up data of keratoplasty patients -: Report on ten years' experience

Background: Influencing factors on medium-term and long-term clear graft survival following penetrating keratoplasty are mostly basically known but their quantitative importance and interaction are far less well established. Due to abundance and complex interaction of influencing factors, comprehensive collection of pre- and postoperative data is imperative. Furthermore, application of stringent quality control as addressed in the German transplantation law established in 1997 is only possible if comprehensive data are available within a database system. Methods: All data from corneas preserved at the Lions cornea bank NRW as well as donor and follow-up data are entered into a custom-relational database system. This system implements management of data concerning the waiting list, the donors, organ culture as well as surgical and follow-up data. In order to demonstrate analysis of these data, 5-year graft survival with respect to preoperative risk assessment is analysed. Results: Data of 1710 donors and 3333 recipients have been entered into the system so far. Clear graft survival 5 years after normal risk keratoplasty is 85%, whereas prognosis of high-risk cases is significantly worse (history of ocular herpes simplex virus keratitis: 80%, increased risk of graft rejection as the only risk factor: 65%, glaucoma: 45%, limbal stem cell insufficiency: 30%; p < 0.05; log-rank test). Conclusions: The database system has proved indispensable for documentation, quality control and research. The implementation of this system is possible at any cornea bank. A common relational database system for cornea banks would of the banks as well as multicentre keratoplasty studies.