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Update on ECCTR

European registry highlights practice patterns in corneal transplantation. Dermot McGrath reports

The first peer-reviewed publications to emerge from the European Cornea and Cell Transplantation Registry (ECCTR) mark an important step forward in understanding the safety, quality and efficacy of corneal transplantation in Europe.

The two studies, which look at European practice patterns and outcome data for corneal transplantation respectively, have recently been accepted for publication by the Journal of Cataract and Refractive Surgery.

“This is significant because I think for the first time these papers give us a picture of what’s really happening in Europe in terms of practice patterns and outcomes for corneal transplantation,” said Mor Dickman MD, PhD, Maastricht University Eye Clinic, Netherlands. “What type of patients are undergoing cornea transplantation? What kind of donors give their corneas for transplantation? Which diseases are the most prevalent?”

Dr Dickman said that while this information might seem banal to some, the reality is that registry data constitutes a mine of valuable data that benefits practitioners and patients.

“Everybody is always looking for the latest invention or technological advancement, but the big picture in terms of what are we doing and who are we doing it for and what are the outcomes thereof – that information or big picture was simply not there. That’s the true significance of these publications – for the first time we have a European endeavour that looks at what we’re doing and gives us a comprehensive overview of our outcomes in the field of corneal transplantation,” he said.

Established in 2016, the ECCTR has now collected data on 13,000 transplants from 12 countries and includes information on the recipient, donor and eye bank processing, transplant procedure and twoyear follow-up including graft survival and failure and patient-reported outcome measures (PROMs).

“There are a lot of interesting findings in the data,” said Dr Dickman. “For example, the youngest patient in the registry is a one-year-old infant with Peter’s anomaly and the oldest person is 101 who underwent a regraft. While these are anecdotal cases, it is nevertheless quite interesting to see that cornea transplantation is being used to help patients across all the entire spectrum of the human life-span,” he said.

REPEAT GRAFTING Fuchs’ endothelial dystrophy is the number one reason for corneal transplantation, noted Dr Dickman. “This makes sense because it’s quite prevalent among Europeans. But what really stands out is the fact that repeated transplants are the second most common indication for corneal transplantation,” he said.

One question this poses, added Dr Dickman, is how cornea transplant care should be organised to optimise outcomes and try to reduce the current high levels of repeat grafting.

“The regrafting rate has to do with the introduction of novel techniques and the learning curves that are associated with them, but also recognising that when we look at the long term, endothelial decompensation and graft rejection do play a role in limiting the survival of grafts. So, the ageing of the population needs to be factored into the equation, as we know that with each retransplant the outcomes are generally less favourable,” he said.

BENCHMARKING Dr Dickman stressed that the primary purpose of the registry is to allow benchmarking and drive quality improvement.

“I think this data is mostly useful for benchmarking, in the sense that it can be used to see what other surgeons are doing and how results compare. There’s a possibility for surgeons to create their own reports in the ECCTR in order to

The youngest patient in the registry is a one-year-old infant with Peter’s anomaly and the oldest person is 101 who underwent a regraft

This is significant because I think for the first time these papers give us a picture of what’s really happening in Europe in terms of practice patterns

Mor Dickman MD, PhD

benchmark their outcomes and get a sense of how well they are performing compared to other European centres,” he said.

Looking at the current spread of participating centres, Dr Dickman said that greater involvement from southern and eastern Europe would be a welcome development.

“In northern Europe, there is a culture of registries going back many years. The acceptance is also driven by insurance companies in countries such as the Netherlands, and in the UK by the requirements of auditing in order to renew one’s license as a practising surgeon. Some donor banks also require registry data as a prerequisite for using their services,” he said.

Looking ahead, Dr Dickman said that the next step is the addition of a limbal stem cell transplant component to the registry.

“This is a very exciting development. For limbal stem cell transplants, we have now a stem cell therapy. Patients undergo this therapy for a myriad of indications. It will be very interesting to know what are the long-term outcomes of these transplants and collect this data on an independent platform” he concluded.

Outcomes of corneal transplantation in Europe: Report by the European Cornea and Cell Transplantation Registry (ECCTR) https://journals.lww.com/jcrs/ Abstract/9000/Outcomes_of_corneal_ transplantation_in_Europe_.99642.aspx