Purpose: To evaluate the success, tolerability, and side effects of systemic immunosuppression (SI) in patients undergoing ocular surface stem cell transplantation (OSST) under the SI protocol used at our institution.

Methods: Retrospective chart review of all patients who had OSST by a single surgeon (EJH) from 1997 to 2007 and received follow-up for systemic immunosuppression. Patients were analyzed for demographics, systemic immunosuppression exposure, adverse side effects, and ocular surface stability.

Results: A total of 142 eyes from 135 patients with a mean age of 43.2 years (range 7.6–86.5 years) underwent OSST with systemic immunosuppression. The most common systemic immunosuppression regimen (94/135 patients, 69.6%) consisted of tacrolimus (target 8–10 ng/mL until 6 months, then 5–8 ng/mL for 12–18 months), mycophenolate mofetil, and a short course (1–3 months) of prednisone. Prophylactic valganciclovir and trimethoprim/sulfamethoxazole (dapsone if sulfa allergy was present) were also used. Mean duration of immunosuppression was 67.7 months (range 3.6–207.8 months) and mean follow-up time following OSST was 106.1 months (range 3.6–233.6 months). At the patients' last follow-up visit, 87/142 eyes (66.2%) had a stable or improved ocular surface. There were 4 severe adverse events in 3 patients (2.2%; 2 myocardial infarction, 1 pulmonary embolus, 1 secondary tumor) and 62 minor adverse events (e.g. transient laboratory abnormality including creatinine and liver function test elevation, transient gastrointestinal symptoms, infection) in 40 patients (29.6%). There was no long-term nephrotoxicity observed in our series. Additionally, there were no deaths related to SI in our series.

Conclusion: The prevention of graft rejection with the use of SI after OSST is critical and should be approached with the same attention as in solid organ transplantation. With appropriate long-term monitoring by a cornea specialist and transplant physician, the risk of irreversible toxicity from modern systemic immunosuppression in these patients can be minimized.

CITATION INFORMATION: Govil A, Cheung A, Sarnicola E, Holland E. Systemic Immunosuppression in the Setting of Ocular Surface Stem Cell Transplantation. Am J Transplant. 2017;17 (suppl 3).

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