Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Association Between the Risk of Corneal Graft Rejection and Vaccination
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
Data on vaccine-associated corneal transplant rejections are limited. We examined the association between graft rejection and vaccination.
DESIGN
Matched case-control METHODS: We used electronic health records to identify corneal transplant recipients between January 2008 and August 2022 at Kaiser Permanente Southern California. Cases were transplant recipients who experienced a graft rejection (outcome) during the study period. Randomly selected controls who did not experience a corneal graft rejection at their matched cases' index date (rejection date) were matched in a 3:1 ratio to cases. For controls, index date was determined by adding the number of days between transplant and graft rejection of their matched case to the control's transplant date.
RESULTS
The study included 601 cases and 1803 matched controls (mean age 66 years [s.d. 17.0], 52% female, 47% non-Hispanic white). Twenty-three% of cases and 22% of controls received ≥1 vaccinations within 12 weeks prior to the index date. The adjusted odds ratio (aOR) for vaccination in the 12 weeks prior to index date, comparing cases to controls was 1.17 (95% CI: 0.91, 1.50]). The aOR was 1.09 (0.84, 1.43) for 1 vaccination, 1.53 (0.90, 2.61) for 2 vaccinations, and 1.79 (0.55, 5.57) for ≥3 vaccinations. The aOR was 1.60 (0.81, 3.14) for mRNA vaccines, and 1.19 (0.80, 1.78) for adjuvanted/high dose vaccines.
CONCLUSIONS
We found no evidence to suggest an association between vaccination and graft rejection. Our findings provide support for the completion of recommended vaccinations for corneal transplant recipients, without significantly increasing the risk of graft rejection.
Additional Info
Disclosure statements are available on the authors' profiles:
Risk of Corneal Graft Rejection and Vaccination: A Matched Case-Control Study From a United States Integrated Health Care System
Am J Ophthalmol 2024 Feb 27;263(n/a)133-140, JH Ku, AA Nanji, JE Tubert, C Joe, D Srikumaran, KL Winthrop, AE Brunton, A Florea, F Fraunfelder, T Tseng, YI LuoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Ku and colleagues have conducted a review of electronic medical records from Kaiser Permanente Southern California using a matched case–control design to investigate the association between corneal graft rejection and vaccination. The authors categorized graft recipients who experienced rejection as cases and those who did not as controls. They analyzed vaccination data within a specific timeframe before the index date, comparing cases and controls to evaluate any potential association. The patients were all aged 18 years and above and were roughly equally divided between recipients of endothelial and penetrating keratoplasties.
No significant association was found between vaccination and corneal graft rejection, even when stratified by the number and type of vaccination. The adjusted odds ratio for vaccination within 12 weeks prior to the index date was 1.17 (95% CI, 0.91–1.50), indicating no substantial association. The subgroup analysis revealed that the adjusted odds ratio was 1.53 (95% CI, 0.90–2.61) for two vaccinations and 1.79 (95% CI, 0.55–5.57) for three or more vaccinations within the same timeframe, suggesting a potential trend towards increased risk of graft rejection, albeit not statistically significant. A similar nonsignificant trend was also observed with mRNA vaccinations.
The study's strengths lie in its use of a large dataset over a significant timeframe and accounting of demographic and clinical covariates as well as potential confounders. The authors acknowledged certain study limitations, including the potential misclassification of outcomes and exposures and the inherent constraints of observational data. The study demonstrated that routine vaccinations for most corneal transplant recipients do not significantly increase the risk of graft rejection. It is possible that this risk is higher in certain populations, such as children or those with vascularized corneas. Larger-scale studies are required to explore this relationship comprehensively. The findings do not provide evidence for or against the practice of prophylactic increase in steroid use around the time of vaccination.