Clinical Predictors of Endothelial Damage in Internationally Transported Donor Corneas

PURPOSE: To identify clinical factors influencing corneal endothelial damage during international transportation by evaluating the condition of donor corneas upon arrival in Japan, representing the real-world scenario faced by importing countries. METHODS: We analyzed 194 donor corneas (from 102 donors; mean age 29.8 years) transported from 3 US eye banks to Japan. All corneas underwent trypan blue staining (0.4%) to quantify endothelial damage, with damaged areas manually traced and analyzed using custom Python-based image analysis. Univariate and multivariate analyses using generalized linear mixed models identified predictors of endothelial damage, with donors stratified into high- and low-damage groups based on median staining rates. RESULTS: Most corneas (62.4%) showed minimal damage (10%). Multivariate analysis identified the following 4 independent predictors of increased endothelial damage: eye bank source (eye bank C vs. A: odds ratio [OR] 4.67, 95% confidence interval [CI] 1.08 to 20.07, P = 0.039), younger donor age (≥31 vs.