Medical and economic impacts of managing corneas from older donors at the tissue bank-a single-center retrospective study spanning over 12 years

Anne-Sophie Hatzfeld; Nicolas Germain; Patrice Maboudou; Mélanie Dhayer; Philippe Marchetti

doi:10.3389/fmed.2024.1415515

Medical and economic impacts of managing corneas from older donors at the tissue bank-a single-center retrospective study spanning over 12 years

Front Med (Lausanne). 2024 Oct 24:11:1415515. doi: 10.3389/fmed.2024.1415515. eCollection 2024.

Authors

Anne-Sophie Hatzfeld¹, Nicolas Germain^{1

2}, Patrice Maboudou³, Mélanie Dhayer², Philippe Marchetti^{1

2}

Affiliations

¹ Tissue Bank of Lille, Biology Pathology Center, CHU Lille, Lille, France.
² UMR 9020-U1277, CANTHER, University Lille, CNRS, Lille, France.
³ Biochemistry Unit, Biology Pathology Center, CHU Lille, Lille, France.

Abstract

Aim: To evaluate the impact of corneas from donors over 80 years of age on the activity of the North of France Tissue Bank and to determine the potential cost implications for banks using corneas from older donors.

Methods: We analyzed data from a single-center retrospective cohort study of 6,023 corneas preserved at the Lille Tissue Bank between 2012 and 2023. Donors, unrestricted by age, were divided into two groups: younger (≤ 80 years) and older (> 80 years). Corneas were categorized based on endothelial cell density (ECD). Data were collected from patients who underwent corneal transplantation. A financial impact model was created to assess the effects of using corneas from different age groups on the overall benefits of corneal transplant procedures.

Results: The average donor age was 67.5 ± 14.5 years. The median age of donors gradually increased from 66 to 73 years over the 12-year study period, with donors over 80 years old representing more than 24% since 2021. Corneas from older donors had a higher discard rate (62.53% vs. 39.66%) due to poor endothelial quality and serological concerns (both p < 0.0001). Additionally, these corneas had lower ECD, with a larger proportion deemed unsuitable for grafting due to low ECD (30% vs. 8.2%). Corneas from younger donors were more often used for endothelial transplants, which require higher ECD. The mean economic benefit per cornea showed a moderate negative correlation with donor age. The net benefit of corneal transplants decreased as the proportion of donors aged over 80 years increased. It is predicted that a net benefit of zero would be attained when the proportion of donors over 80 years is 44.4%.

Conclusion: Using corneas from donors over 80 years of age can help alleviate the shortage of donor tissue and be effective if certain quality standards are met. However, additional costs incurred by eye banks must be factored into this equation.

Keywords: age; cornea; donor; endothelial cell density; storage; tissue bank.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by CHU Lille. MD received a postdoctoral fellowship for the hypofill project (RAPID program). PMar received a funding support from Association des Gueules Cassées.