Our Summary

This research paper talks about a 77-year-old man who had a corneal transplant rejection. He was receiving a drug called durvalumab as part of his treatment for a type of lung cancer. After he had a successful course of chemotherapy and radiation, and started on durvalumab, he had a corneal transplant to treat a disease of his cornea. Initially, everything seemed fine, but six months later, he started to lose his vision. Unfortunately, the transplant was eventually considered a failure a year later, even though he was using a type of steroid eye drop. This case adds to a small but growing body of evidence suggesting that certain kinds of drugs that work on the immune system may contribute to the body rejecting a corneal transplant. Because of this, the authors suggest that patients who receive a corneal transplant and are also taking these drugs need to be closely watched and evaluated by a team of healthcare professionals.

FAQs

  1. What was the cause of corneal transplant rejection in the reported case?
  2. What is the potential relationship between immune checkpoint inhibitors and corneal graft rejection?
  3. Why is it essential for corneal transplant recipients undergoing ICI therapy to have multidisciplinary evaluation and close monitoring?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to closely follow the prescribed medication regimen, especially any immunosuppressive medications, to reduce the risk of rejection. It is also important to attend all follow-up appointments with the ophthalmologist to monitor the health of the transplant and address any issues promptly. Additionally, patients should inform their healthcare providers if they are considering starting any new medications, as some medications can interact with immunosuppressants and affect the success of the transplant.

Suitable For

Corneal transplant is typically recommended for patients with corneal diseases or conditions that cannot be managed effectively with other treatment options, such as:

  1. Keratoconus: a progressive thinning and bulging of the cornea, leading to distorted vision.

  2. Corneal scarring: caused by injury, infection, or other factors, resulting in reduced visual acuity.

  3. Fuchs’ dystrophy: a genetic disorder affecting the corneal endothelium, leading to corneal edema and vision loss.

  4. Corneal degeneration: age-related changes in the cornea that can affect vision.

  5. Corneal transplant rejection: when the body’s immune system attacks the transplanted cornea, leading to graft failure.

  6. Other corneal diseases or conditions that cannot be managed effectively with conservative treatment options.

It is important for patients undergoing corneal transplant to be monitored closely by their healthcare providers and to follow post-operative care instructions to maximize the success of the procedure.

Timeline

  • Before corneal transplant:
  1. Patient diagnosed with corneal dystrophy
  2. Patient undergoes successful chemoradiation for stage IIIB non-small cell lung cancer
  3. Patient initiates durvalumab as consolidative therapy
  4. Patient experiences progressive visual decline despite stable post-transplant course
  5. Graft failure occurs 1 year after corneal transplant despite treatment with prednisone eye drops
  • After corneal transplant:
  1. Patient undergoes right corneal transplant for corneal dystrophy
  2. Initially stable post-transplant course for six months
  3. Progressive visual decline occurs
  4. Graft failure happens 1 year after corneal transplant
  5. Patient receives treatment with prednisone eye drops, but graft rejection persists
  6. Multidisciplinary evaluation and close monitoring of patient’s condition is emphasized

What to Ask Your Doctor

  1. What are the potential risks and complications of corneal transplant rejection, particularly in the context of receiving immune checkpoint inhibitors like durvalumab?

  2. How will my current medication regimen, including durvalumab, impact the success of my corneal transplant and my risk of rejection?

  3. What symptoms should I watch out for that may indicate my corneal transplant is being rejected, and when should I seek medical attention?

  4. How often should I have follow-up appointments to monitor the health of my corneal transplant while I am receiving durvalumab?

  5. Are there any specific precautions or lifestyle changes I should consider to protect my corneal transplant while on durvalumab?

  6. How will durvalumab interact with any medications I may need to take post-transplant to prevent rejection?

  7. Are there any alternative treatments or management strategies that may reduce my risk of corneal transplant rejection while receiving durvalumab?

  8. How will my overall health and immune system function impact the success of my corneal transplant while on durvalumab?

  9. What is the expected prognosis for my corneal transplant given my medical history and current treatment plan with durvalumab?

  10. Are there any additional resources or support services available to help me navigate the potential challenges of managing a corneal transplant while undergoing treatment with durvalumab?

Reference

Authors: Froessl L, Panwar P, Bhatia S, Dowell J. Journal: J Immunother. 2025 Jan 1;48(1):32-33. doi: 10.1097/CJI.0000000000000536. Epub 2024 Jul 30. PMID: 39075873