Corneal transplant rejection: principles and clinical management

Corneal transplantation is the most common form of tissue transplant in New Zealand with more than 300 cases performed annually. As widely-known, the primary indication for corneal transplantation in New Zealand over the last 25 years is keratoconus¹. Fortunately, keratoconus as an indication is typically associated with good long-term survival, being in the region of 90% at 10 years in the Australian Graft Registry. Nevertheless, the most common cause of transplant failure in both penetrating and endothelial transplant is allograft rejection². This brief review will consider the “relative” immune privilege of the cornea, the associations of allograft rejection and the current clinical diagnosis and management options.