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This study seeks to determine whether recipient diabetes status relates to incidence of immune rejection following Descemet Stripping Endothelial Keratoplasty (DSEK). We hypothesized that patients with diabetes would have a greater risk of graft immune rejection.

This is a retrospective cohort study to compare recipient diabetes status in 794 DSEK surgeries at Wills Eye Hospital between January 2008 and July 2019. Kaplan-Meier functions of survival time until first immune rejection was compared between groups. Pearson’s chi square test and Wilcoxon test were used to test the null hypothesis.

During the study period, 146 of 794 DSEK recipients had diabetes. At 1 year, diabetics had a significantly higher risk of immune graft rejection compared to non-diabetics (OR 2.28, p=0.047). Likewise, there was a reduced rejection free mean survival time in diabetics (6.9 vs 8.9 years) as well as a significant difference in hazard functions (p=0.044).

Recipient diabetes confers a greater risk of immune rejection following DSEK. This may have implications for counseling, monitoring, and managing post-operative steroid regimens in this at risk population.