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Journal of Ophthalmology
Volume 2012, Article ID 576712, 5 pages
Clinical Study

Adverse Effects of Systemic Immunosuppression in Keratolimbal Allograft

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA

Received 10 November 2011; Accepted 22 December 2011

Academic Editor: Andrew G. Lee

Copyright © 2012 M. Krakauer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. Keratolimbal allograft (KLAL) is a treatment for limbal stem cell deficiency. One disadvantage is systemic immunosuppression to avoid rejection. Our purpose was to examine the adverse effects of systemic immunosuppression in KLAL. Methods. A retrospective case review of 16 patients with KLAL who received systemic immunosuppression consisting of a corticosteroid, an antimetabolite, and/or a calcineurin inhibitor was performed. Patients were monitored for signs, symptoms, or laboratory evidence of toxicity. Results. Twelve of 16 patients (75%) experienced an adverse effect. The average age of those with adverse effects was 50.0 years (SD 17.8) and those without was 23.6 years (SD: 14.3), which was statistically significant (unpaired t-test P=0.022). Ten of 11 patients (91%) had resolution during mean followup of 16.4 months. No serious adverse effects occurred. The most common included anemia, hyperglycemia, elevated creatinine, and elevated liver function tests. Prednisone and tacrolimus were responsible for the most adverse effects. More patients with comorbidities experienced adverse effects (83%) than those without comorbidities (25%). Conclusions. KLAL requires prolonged systemic immunosuppression. Our data demonstrated that systemic immunosuppression did not result in serious adverse effects in our population and is relatively safe with monitoring for toxicity. In addition, we demonstrated that adverse effects occurred more frequently in older patients and those with comorbidities.