BMJ Open · 7 authors, 11 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This case-control study of 1517 corneas found that COPD and diabetes significantly reduce corneal tissue and implant viability, while smoking and alcohol consumption were associated with increased viability. These findings suggest that assessing cardiovascular risk factors can help predict corneal tissue quality and guide donor selection in the absence of absolute exclusion criteria.
**Background:** Corneal transplantation relies on donor tissue quality, which may be affected by donor comorbidities. With increasing donor age and prevalence of cardiovascular risk factors (CVRFs), understanding their impact on corneal viability is crucial for donor selection. This study evaluated the influence of arterial hypertension (AHT), diabetes, dyslipidaemia, smoking, alcoholism, and chronic obstructive pulmonary disease (COPD) on donor, tissue, and implant viability.
**Methods:** An observational case-control study was conducted at Coruña University Hospital Complex (Spain) using the SIMON database. All 1517 multiorgan and tissue donors between 2017 and 2019 were included; 111 (7.4%) were excluded due to ocular alterations, positive serology, uncontrolled sepsis, neurological diseases, or CNS tumors. Data collected included age, sex, CVRFs, donor type, and corneal evaluation results. Tissue viability was determined by specular microscopy (SM) assessing cell density (CD, normal >2000 cells/mm²), coefficient of variation (CV, normal 33%-40%), and hexagonality (HEX, normal >50%), and by slit lamp (SL) evaluation. Implant viability required both donor and tissue viability. Statistical analysis used χ² tests, Student's t-test or Mann-Whitney U test, and logistic regression with OR and 95% CI; significance set at p<0.05.
**Key Results:** Mean donor age was 61.3 (SD 12.7) years; 55.6% were male; 81.5% had at least one CVRF. Donor viability was 93% (1411/1517). COPD reduced donor viability (no COPD: 93.8% vs COPD: 88%; OR=0.49; 95% CI: 0.28 to 0.84), while alcohol consumption increased it (drinker/ex-drinker: 95.8% vs non-drinker: 92.5%; OR=1.84; 95% CI: 1.01 to 3.33). Tissue viability was 71.7% (1083/1517). Decreased tissue viability was associated with COPD (no COPD: 72.5% vs COPD: 64%; OR=0.67; 95% CI: 0.47 to 0.96) and diabetes (no diabetes: 72.9% vs diabetes: 67.2%; OR=0.76; 95% CI: 0.58 to 0.99). By SM, diabetes reduced viability (no diabetes: 85.5% vs diabetes: 77.2%; OR=0.57; 95% CI: 0.42 to 0.78). By SL, smoking increased viability (no habit: 78.7% vs habit: 86.4%; OR=1.72; 95% CI: 1.29 to 2.30). Implant viability was 68.9% (1039/1517). COPD decreased implant viability (no COPD: 69.8% vs COPD: 60.7%; OR=0.67; 95% CI: 0.47 to 0.94), while smoking increased it (no habit: 65.3% vs habit: 74.1%; OR=1.52; 95% CI: 1.21 to 1.91). Multivariate logistic regression confirmed these associations.
**Clinical Implications:** This study demonstrates that CVRFs, particularly COPD and diabetes, negatively impact corneal tissue quality and implant suitability, while smoking and alcohol consumption paradoxically appear protective. These findings can guide donor selection by providing additional criteria beyond absolute exclusion factors, potentially improving transplant outcomes. The protective effect of smoking contradicts prior literature and warrants further investigation. Limitations include the observational design and single-center setting. Future research should explore mechanisms and validate these associations in larger, diverse populations.