Microbial Contamination of Donor Corneas and Post-keratoplasty Endophthalmitis: A Comparison Between Japanese and U.S. Eye Banks Using Cold Storage

Microbial Contamination of Donor Corneas and Post-keratoplasty Endophthalmitis: A Comparison Between Japanese and U.S. Eye Banks Using Cold Storage | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Microbial Contamination of Donor Corneas and Post-keratoplasty Endophthalmitis: A Comparison Between Japanese and U.S. Eye Banks Using Cold Storage Naoya Nakagawa, Yuto Yukari, Ami Igarashi, Masato Takeda, Yuki Mizuki, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9439199/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract This study evaluated the prevalence and microbial spectrum of positive corneoscleral donor rim cultures and the associated risk factors for post-keratoplasty infection in Japan. We retrospectively included consecutive corneal transplantations performed by a single surgeon between April 2015 and September 2021. Donor corneas were obtained from eye banks in Japan (n = 134) or the United States (n = 365) and preserved using cold storage. Donor corneoscleral rim cultures were obtained during surgery. Culture positivity and microbial profiles were analyzed. Risk factors for contamination were evaluated using logistic regression. Overall, 78 (15.6%) were culture-positive. Domestic grafts had significantly higher microbial contamination rates than overseas grafts (30.6% vs. 10.1%, P < 0.001), whereas fungal contamination rates did not differ between groups (1.5% vs. 1.9%, P = 1.000). In the multivariate analysis, overseas eye bank origin was independently associated with a lower risk of microbial contamination (OR 0.259, 95% CI, 0.139–0.486; P < 0.001). Post-keratoplasty endophthalmitis occurred in three cases (0.6%), all of which were associated with positive fungal cultures. Therefore, fungal pathogens may play a key role in increasing clinically significant postoperative endophthalmitis risk after keratoplasty, highlighting the importance of targeted donor tissue screening and postoperative management. Health sciences/Diseases Health sciences/Medical research Biological sciences/Microbiology Health sciences/Risk factors fungal endophthalmitis corneal transplant eye banking donor rim cultures fortified preservation media transplant infection Figures Figure 1 Introduction Corneal transplantation is widely performed as an effective treatment for corneal endothelial disorders, corneal opacity, and hereditary corneal diseases. According to a global survey, more than 180,000 corneal transplantations are performed annually. Recent advances in surgical techniques have led to the development of less invasive corneal transplantation procedures, including deep anterior lamellar keratoplasty (DALK), Descemet's stripping automated endothelial keratoplasty (DSAEK), Descemet’s membrane endothelial keratoplasty (DMEK), and conventional penetrating keratoplasty (PKP), increasing the number of procedures performed worldwide. [ 1 – 3 ] However, postoperative infectious complications remain a significant concern, with an incidence of infections such as keratitis or endophthalmitis following corneal transplantation known to be higher than that associated with other intraocular surgeries. [ 4 , 5 ] Reports from the Eye Banking Association of America (EBAA) show an increasing trend in infections following keratoplasty. [ 6 ] In particular, endophthalmitis, caused by bacterial or fungal infections, often leads to severe visual impairment and poor visual outcomes. [ 7 – 9 ] Various microorganisms have been reported as causative pathogens of post-keratoplasty infections, including gram-positive cocci, gram-negative bacilli, and fungi such as Candida, Aspergillus , and Fusarium . [ 8 , 10 , 11 ] Among these, fungal endophthalmitis is particularly difficult to treat and is frequently associated with graft removal, regrafting, and poor visual prognosis. [ 12 , 13 ] In addition, previous studies have demonstrated that donor-related factors play important roles in the development of postoperative infections. Positive donor corneoscleral rim cultures are reported in approximately 7–15% of cases and may be associated with an increased risk of postoperative infection. [ 10 ] Several risk factors for post-keratoplasty infection have been reported, including donor-related factors, preservation conditions of the donor tissue, and the interval between tissue procurement and transplantation. Previous studies have also suggested that contamination of donor corneas with bacteria or fungi may increase the risk of postoperative infection. [ 6 , 14 ] Despite these findings, it remains unclear whether microbial contamination rates differ between eye bank systems across countries and whether such differences translate into clinically relevant infection risks. While eye bank practices, including donor selection, tissue procurement, and handling procedures, vary substantially between regions and may influence microbial contamination of donor tissues, direct comparisons between domestic and international eye banks under similar clinical conditions are limited. Therefore, this study aimed to compare the prevalence and microbial spectrum of donor corneoscleral rim contamination between Japanese and U.S. eye banks and to evaluate its association with postoperative infection following keratoplasty. Methods Study design and patients This study was approved by the Institutional Review Board of Nihon University Hospital (approval no. RK-230411-8), and adhered to the tenets of the Declaration of Helsinki. All patients provided informed consent in the form of opto-outs on the website. Patients who refused to participate were excluded. The retrospective study population comprised eyes that underwent keratoplasty at Yokohama Minami Kyosai Hospital and the Kikuna Yuda Eye Clinic between April 2015, and September 2021. Surgical procedures included PKP, lamellar keratoplasty (LKP), DALK, DMEK, and DSAEK. All corneal transplantation procedures were performed by a single surgeon (T.H.). Clinical data were accessed and analyzed by investigators who were formally approved Institutional Review Board members or collaborators between May 1, 2025, and December 31, 2025. Data sharing across institutions was conducted in a fully anonymized manner, and no personally identifiable information was accessible to the investigators outside the institution of origin. Donor corneas were obtained from domestic eye banks in Japan (Chiba, Saitama, Osaka, Toyama, Gifu, Kanagawa, Gunma, Nagasaki, Nagano, and Shizuoka) and overseas eye banks (CorneaGen, Lions Eye Institute, Mid-America Transplant, and Cincinnati Eye Bank). All donor corneas were preserved in Optisol-GS storage medium (Bausch and Lomb) under standard hypothermic conditions. At the time of surgery, a portion of the donor corneoscleral rim was aseptically obtained before transplantation and transferred to a sterile transport container (under anaerobic conditions when required) for microbiological culture. Microbiological examination The collected donor corneal specimens were aseptically divided and inoculated into four types of culture media: CHROMagar Candida Plus agar, Brucella HK agar, sheep blood agar, and chocolate II agar. For bacterial detection, cultures were incubated aerobically at 35°C for 72 h. Agar plates were examined at 24-h intervals for colony formation. When bacterial colonies were observed, the organisms were sub-cultured on sheep blood agar for isolation and subsequently identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) according to standard laboratory protocols. For fungal detection, colonies observed on CHROMagar Candida Plus agar were sub-cultured on potato dextrose agar and incubated under appropriate conditions to promote fungal growth. Fungal species were identified based on the colony morphology and microscopic examination using lactophenol cotton blue staining. Brucella HK agar was used for the detection of anaerobic bacteria under anaerobic conditions. Donor corneas in which bacterial or fungal organisms were detected were defined as culture-positive. Bacterial and fungal contaminations were analyzed separately. All microbiological procedures were performed in accordance with standard clinical microbiology laboratory guidelines. Data collection Clinical variables were collected for both recipients and donors. Recipient variables included age, sex, preoperative diagnosis, surgical procedure, medical history (diabetes mellitus, hypertension, dyslipidemia, and heart disease), and use of anticoagulant medications. Donor variables included donor age, donor sex, cause of death, donor medical history (hypertension, diabetes mellitus, and dyslipidemia), and interval between donor death and graft preparation (preservation time). Statistical analysis The demographic and clinical characteristics of corneal graft donors from domestic and overseas eye banks were compared (Table 1 ). Continuous variables, including donor age and graft preparation time, were summarized as mean (standard deviation [SD]) and median [range] and compared using the Wilcoxon rank-sum test. Categorical variables, including donor sex, race, cause of death, hypertension, diabetes mellitus, dyslipidemia, microbial culture results, fungal culture results, bacterial culture results, and bacterial species, were summarized as frequencies and percentages and compared using Pearson’s chi-square test. Race categories were based on eye bank–provided classifications. Table 1 Clinical characteristics of corneal graft donors by eye bank location Item [unit] Statistics category Overall (N = 499) Location of eye bank Comparison [1] vs. [2] [1] Domestic (N = 134) [2] Overseas (N = 365) Donor age [years] Mean (SD), N 69.1 (12.9), 499 81.5 (13.6), 134 64.6 (9.1), 365 P < 0.001 Median [range] 68.0 [15, 102] 84.0 [15, 102] 66.0 [21, 101] Sex [1] Male 275 (55.1%) 71 (53.0%) 204 (55.9%) P = 0.670 [2] Female 222 (44.5%) 62 (46.3%) 160 (43.8%) [3] Unknown 2 (0.4%) 1 (0.7%) 1 (0.3%) Donor race [1] Caucasian 321 (64.3%) 1 (0.7%) 320 (87.7%) P < 0.001 [2] Asian 142 (28.5%) 133 (99.3%) 9 (2.5%) [3] Black 15 (3.0%) 0 (0.0%) 15 (4.1%) [4] Hispanic 13 (2.6%) 0 (0.0%) 13 (3.6%) [5] Native American 3 (0.6%) 0 (0.0%) 3 (0.8%) [6] Other 1 (0.2%) 0 (0.0%) 1 (0.3%) [7] Unknown 4 (0.8%) 0 (0.0%) 4 (1.1%) Cause of death [1] Cancer 121 (24.2%) 26 (19.4%) 95 (26.0%) P < 0.001 [2] Heart disease 120 (24.0%) 20 (14.9%) 100 (27.4%) [3] Multiple organ failure 66 (13.2%) 7 (5.2%) 59 (16.2%) [4] Stroke 53 (10.6%) 18 (13.4%) 35 (9.6%) [5] Respiratory failure 52 (10.4%) 12 (9.0%) 40 (11.0%) [6] Infection 45 (9.0%) 27 (20.1%) 18 (4.9%) [7] Old age 21 (4.2%) 21 (15.7%) 0 (0.0%) [8] Trauma 21 (4.2%) 3 (2.2%) 18 (4.9%) Hypertension [1] No 160 (32.1%) 13 (9.7%) 147 (40.3%) P = 0.001 [2] Yes 210 (42.1%) 2 (1.5%) 208 (57.0%) [3] Unknown 129 (25.9%) 119 (88.8%) 10 (2.7%) Diabetes mellitus [1] No 272 (54.5%) 13 (9.7%) 259 (71.0%) P = 0.379 [2] Yes 98 (19.6%) 2 (1.5%) 96 (26.3%) [3] Unknown 129 (25.9%) 119 (88.8%) 10 (2.7%) Dyslipidemia [1] No 256 (51.3%) 15 (11.2%) 241 (66.0%) P = 0.019 [2] Yes 114 (22.8%) 0 (0.0%) 114 (31.2%) [3] Unknown 129 (25.9%) 119 (88.8%) 10 (2.7%) Death to preparation [h] Mean (SD), N 11.01 (5.50), 427 8.99 (5.73), 102 11.64 (5.28), 325 P < 0.001 Median [range] 10.00 [1.5, 23.9] 7.32 [1.5, 23.8] 10.62 [2.8, 23.9] Microbial culture [1] Negative 421 (84.4%) 93 (69.4%) 328 (89.9%) P < 0.001 [2] Positive 78 (15.6%) 41 (30.6%) 37 (10.1%) Fungal culture [1] Negative 490 (98.2%) 132 (98.5%) 358 (98.1%) P = 1.000 [2] Positive 9 (1.8%) 2 (1.5%) 7 (1.9%) Bacterial culture [1] Negative 430 (86.2%) 95 (70.9%) 335 (91.8%) P < 0.001 [2] Positive 69 (13.8%) 39 (29.1%) 30 (8.2%) Bacterial species [1] gpc 53 (10.6%) 31 (23.1%) 22 (6.0%) P = 0.729 [2] gpr 7 (1.4%) 4 (3.0%) 3 (0.8%) [3] gnr 3 (0.6%) 1 (0.7%) 2 (0.5%) [4] gpc + gnr 2 (0.4%) 1 (0.7%) 1 (0.3%) [5] gnr + gnr 1 (0.2%) 0 (0.0%) 1 (0.3%) [6] gnr + gpr 1 (0.2%) 1 (0.7%) 0 (0.0%) [7] gpc + gpr 1 (0.2%) 1 (0.7%) 0 (0.0%) Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson’s chi-squared test. Participants with missing or unknown data were excluded from analysis. gpc, gram-positive cocci; gpr, gram-positive rods; gnr, gram-negative rods; SD, standard deviation. The clinical characteristics of corneal graft recipients from domestic and overseas eye banks were compared (Table 2 ). Continuous variables including recipient age were compared using the Wilcoxon rank-sum test. Categorical variables, including recipient sex, laterality, preoperative diagnosis, surgical procedure, glaucoma, diabetes mellitus, hypertension, heart disease, and occurrence of post-keratoplasty endophthalmitis, were compared using Pearson’s chi-squared test. Table 2 Clinical characteristics of corneal graft recipients by eye bank location Item [unit] Statistics category Overall (N = 499) Location of eye bank Comparison [1] vs. [2] [1] Domestic (N = 134) [2] Overseas (N = 365) Recipient age [years] Mean (SD), N 69.8 (14.9), 492 68.0 (17.0), 131 70.4 (14.1), 361 P = 0.383 Median [range] 73.0 [6, 91] 73.0 [6, 89] 74.0 [17, 91] Recipient sex [1] Male 225 (45.1%) 57 (42.5%) 168 (46.0%) P = 0.581 [2] Female 272 (54.5%) 76 (56.7%) 196 (53.7%) [3] Unknown 2 (0.4%) 1 (0.7%) 1 (0.3%) Right or left eye [1] Right 262 (52.5%) 74 (55.2%) 188 (51.5%) P = 0.510 [2] Left 234 (46.9%) 59 (44.0%) 175 (47.9%) [3] Unknown 3 (0.6%) 1 (0.7%) 2 (0.5%) Diagnosis [1] BK 225 (45.1%) 16 (11.9%) 209 (57.3%) P < 0.001 [2] Opacity 107 (21.4%) 47 (35.1%) 60 (16.4%) [3] Failed KP 70 (14.0%) 12 (9.0%) 58 (15.9%) [4] Corneal thinning 66 (13.2%) 52 (38.8%) 14 (3.8%) [5] KC 31 (6.2%) 7 (5.2%) 24 (6.6%) Procedure [1] DMEK 154 (30.9%) 4 (3.0%) 150 (41.1%) P < 0.001 [2] PKP 125 (25.1%) 49 (36.6%) 76 (20.8%) [3] DALK 91 (18.2%) 37 (27.6%) 54 (14.8%) [4] DSAEK 78 (15.6%) 2 (1.5%) 76 (20.8%) [5] LKP 51 (10.2%) 42 (31.3%) 9 (2.5%) Endophthalmitis after transplantation [1] Negative 496 (99.4%) 134 (100.0%) 362 (99.2%) P = 0.690 [2] Positive 3 (0.6%) 0 (0.0%) 3 (0.8%) Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson’s chi-squared test. Participants with missing or unknown data were excluded from analysis. BK, bullous keratopathy; KP, keratoplasty; KC, keratoconus; DMEK, Descemet’s membrane endothelial keratoplasty; PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; DSAEK, Descemet’s stripping automated endothelial keratoplasty; LKP, lamellar keratoplasty; SD, standard deviation. Donor and recipient characteristics were compared between patients with and without post-keratoplasty endophthalmitis (Table 3 ). Given the small number of endophthalmitis cases, continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Fisher’s exact test. Table 3 Clinical characteristics of donors and recipients with or without post-keratoplasty endophthalmitis Item [unit] Statistics category Post-keratoplasty endophthalmitis Comparison [1] vs. [2] [1] Negative (N = 496) [2] Positive (N = 3) Eye bank location [1] Domestic 134 (27.0%) 0 (0.0%) P = 0.568 [2] Overseas 362 (73.0%) 3 (100.0%) Donor age [years] Mean (SD), N 69.2 (12.9), 496 56.0 (1.0), 3 P = 0.017 Median [range] 69.0 [15, 102] 56.0 [55, 57] Donor sex [1] Male 274 (55.2%) 1 (33.3%) P = 0.589 [2] Female 220 (44.4%) 2 (66.7%) [3] Unknown 2 (0.4%) 0 (0.0%) Donor race [1] Caucasian 318 (64.1%) 3 (100.0%) P = 0.625 [2] Asian 142 (28.6%) 0 (0.0%) [3] Black 15 (3.0%) 0 (0.0%) [4] Hispanic 13 (2.6%) 0 (0.0%) [5] Native American 3 (0.6%) 0 (0.0%) [6] Other 1 (0.2%) 0 (0.0%) [7] Unknown 4 (0.8%) 0 (0.0%) Donor cause of death [1] Cancer 121 (24.4%) 0 (0.0%) P = 0.025 [2] Heart disease 120 (24.2%) 0 (0.0%) [3] Multiple organ failure 64 (12.9%) 2 (66.7%) [4] Stroke 53 (10.7%) 0 (0.0%) [5] Respiratory failure 52 (10.5%) 0 (0.0%) [6] Infection 45 (9.1%) 0 (0.0%) [7] Old age 21 (4.2%) 0 (0.0%) [8] Trauma 20 (4.0%) 1 (33.3%) Donor hypertension [1] No 158 (31.9%) 2 (66.7%) P = 0.581 [2] Yes 209 (42.1%) 1 (33.3%) [3] Unknown 129 (26.0%) 0 (0.0%) Donor diabetes mellitus [1] No 269 (54.2%) 3 (100.0%) P = 0.569 [2] Yes 98 (19.8%) 0 (0.0%) [3] Unknown 129 (26.0%) 0 (0.0%) Donor dyslipidemia [1] No 253 (51.0%) 3 (100.0%) P = 0.556 [2] Yes 114 (23.0%) 0 (0.0%) [3] Unknown 129 (26.0%) 0 (0.0%) Death to preparation [h] Mean (SD), N 11.01 (5.51), 426 8.55 (NA), 1 P = 0.761 Median [range] 10.03 [1.5, 23.9] 8.55 [8.6, 8.6] Microbial culture [1] Negative 421 (84.9%) 0 (0.0%) P = 0.004 [2] Positive 75 (15.1%) 3 (100.0%) Fungal culture [1] Negative 490 (98.8%) 0 (0.0%) P < 0.001 [2] Positive 6 (1.2%) 3 (100.0%) Bacterial culture [1] Negative 427 (86.1%) 3 (100.0%) P = 1.000 [2] Positive 69 (13.9%) 0 (0.0%) Recipient, Age [years] Mean (SD), N 69.7 (15.0), 489 81.7 (1.5), 3 P = 0.049 Median [range] 73.0 [6, 91] 82.0 [80, 83] Recipient, Sex [1] Male 225 (45.4%) 0 (0.0%) P = 0.255 [2] Female 269 (54.2%) 3 (100.0%) [3] Unknown 2 (0.4%) 0 (0.0%) Right or left eye [1] Right 262 (52.8%) 0 (0.0%) P = 0.104 [2] Left 231 (46.6%) 3 (100.0%) [3] Unknown 3 (0.6%) 0 (0.0%) Diagnosis [1] BK 222 (44.8%) 3 (100.0%) P = 0.874 [2] Opacity 107 (21.6%) 0 (0.0%) [3] Failed KP 70 (14.1%) 0 (0.0%) [4] Corneal thinning 66 (13.3%) 0 (0.0%) [5] KC 31 (6.2%) 0 (0.0%) Procedure [1] DMEK 153 (30.8%) 1 (33.3%) P = 0.171 [2] PKP 125 (25.2%) 0 (0.0%) [3] DALK 91 (18.3%) 0 (0.0%) [4] DSAEK 76 (15.3%) 2 (66.7%) [5] LKP 51 (10.3%) 0 (0.0%) Recipient glaucoma [1] No 489 (98.6%) 3 (100.0%) P = 1.000 [2] Yes 2 (0.4%) 0 (0.0%) [3] Unknown 5 (1.0%) 0 (0.0%) Recipient diabetes mellitus [1] No 466 (94.0%) 3 (100.0%) P = 1.000 [2] Yes 26 (5.2%) 0 (0.0%) [3] Unknown 4 (0.8%) 0 (0.0%) Recipient hypertension [1] No 488 (98.4%) 3 (100.0%) P = 1.000 [2] Yes 4 (0.8%) 0 (0.0%) [3] Unknown 4 (0.8%) 0 (0.0%) Recipient heart disease [1] No 476 (96.0%) 3 (100.0%) P = 1.000 [2] Yes 9 (1.8%) 0 (0.0%) [3] Unknown 11 (2.2%) 0 (0.0%) Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Fisher’s exact test. Participants with missing or unknown data were excluded from analysis. BK, bullous keratopathy; KP, keratoplasty; KC, keratoconus; DMEK, Descemet’s membrane endothelial keratoplasty; PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; DSAEK, Descemet’s stripping automated endothelial keratoplasty; LKP, lamellar keratoplasty; SD, standard deviation. Donor characteristics were stratified according to microbial graft culture results (positive vs. negative) to identify potential factors associated with graft contamination (Table 4 ). Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson’s chi-squared test. Table 4 Clinical characteristics of donors stratified by microbial graft culture results Item [unit] Statistics category Microbial graft culture Comparison [1] vs. [2] [1] Negative (N = 421) [2] Positive (N = 78) Eye bank location [1] Domestic 93 (22.1%) 41 (52.6%) P < 0.001 [2] Overseas 328 (77.9%) 37 (47.4%) Donor age [years] Mean (SD), N 68.3 (12.2), 421 73.6 (15.7), 78 P < 0.001 Median [range] 68.0 [16, 102] 74.5 [15, 97] Donor sex [1] Male 238 (56.5%) 37 (47.4%) P = 0.160 [2] Female 181 (43.0%) 41 (52.6%) [3] Unknown 2 (0.5%) 0 (0.0%) Donor race [1] Caucasian 290 (68.9%) 31 (39.7%) P < 0.001 [2] Asian 99 (23.5%) 43 (55.1%) [3] Black 15 (3.6%) 0 (0.0%) [4] Hispanic 10 (2.4%) 3 (3.8%) [5] Native American 3 (0.7%) 0 (0.0%) [6] Other 1 (0.2%) 0 (0.0%) [7] Unknown 3 (0.7%) 1 (1.3%) Donor cause of death [1] Cancer 102 (24.2%) 19 (24.4%) P = 0.958 [2] Heart disease 102 (24.2%) 18 (23.1%) [3] Multiple organ failure 57 (13.5%) 9 (11.5%) [4] Stroke 45 (10.7%) 8 (10.3%) [5] Respiratory failure 42 (10.0%) 10 (12.8%) [6] Infection 39 (9.3%) 6 (7.7%) [7] Old age 16 (3.8%) 5 (6.4%) [8] Trauma 18 (4.3%) 3 (3.8%) Donor hypertension [1] No 143 (34.0%) 17 (21.8%) P = 0.981 [2] Yes 189 (44.9%) 21 (26.9%) [3] Unknown 89 (21.1%) 40 (51.3%) Donor diabetes mellitus [1] No 241 (57.2%) 31 (39.7%) P = 0.320 [2] Yes 91 (21.6%) 7 (9.0%) [3] Unknown 89 (21.1%) 40 (51.3%) Donor dyslipidemia [1] No 229 (54.4%) 27 (34.6%) P = 0.938 [2] Yes 103 (24.5%) 11 (14.1%) [3] Unknown 89 (21.1%) 40 (51.3%) Death to preparation [h] Mean (SD), N 11.06 (5.42), 365 10.68 (5.98), 62 P = 0.496 Median [range] 10.05 [1.6, 23.9] 8.97 [1.5, 23.6] Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson’s chi-squared test. Participants with missing or unknown data were excluded from analysis. SD, standard deviation. Logistic regression analysis was used to identify independent risk factors for microbial graft culture positivity (Table 5 ). Eye bank location and donor age (per 10-year increment) were included as explanatory variables. Both univariate and multivariate models were fitted, and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Variables with missing or unavailable data were categorized as “unknown” and included in the analysis where appropriate. Table 5 Risk factor analysis for microbial graft culture positivity using logistic regression model Explanatory variable Category Unit Univariable model Multivariable model Odds ratio 95% CI P value Odds ratio 95% CI P value Eye bank location [1] Domestic Reference - - Reference - - [2] Overseas 0.256 [0.155, 0.422] < 0.001 0.259 [0.139, 0.486] < 0.001 Donor age 10 years 1.385 [1.143, 1.686] 0.001 1.007 [0.812, 1.266] 0.952 CI, confidence interval. All statistical analyses were performed using a two-sided significance level of P < 0.05. Participants with missing or unknown data were excluded from analysis. All statistical analyses were performed using R version 4.5.1 (R Foundation for Statistical Computing, Vienna, Austria). Results Donor characteristics by eye bank location Among 499 corneal grafts included in this study, 134 (26.9%) were obtained from domestic eye banks and 365 (73.1%) from overseas eye banks (Table 1 ). The mean donor age was significantly higher in the domestic group (81.5 ± 13.6 years) compared with the overseas group (64.6 ± 9.1 years; P < 0.001). There was no significant difference in the donor sex between the two groups (P = 0.670). The racial composition differed significantly between the groups; domestic donors were predominantly Asian (99.3%), whereas overseas donors were predominantly Caucasian (87.7%; P < 0.001). The distribution of causes of death also differed significantly (P < 0.001), with infection (20.1%) and old age (15.7%) being more common among domestic donors, whereas heart disease (27.4%) and cancer (26.0%) were more prevalent among overseas donors. Among donors with available comorbidity data, hypertension (P = 0.001) and dyslipidemia (P = 0.019) were significantly more common in the overseas group, whereas diabetes mellitus showed no significant difference (P = 0.379). The mean graft preparation time was significantly shorter for domestic grafts (8.99 ± 5.73 h) than for overseas grafts (11.64 ± 5.28 h; P < 0.001). The overall rate of positive microbial cultures was 15.6%, which was significantly higher in the domestic group (30.6%) than that in the overseas group (10.1%; P < 0.001). Similarly, the rate of positive bacterial cultures was significantly higher in the domestic group (29.1% vs. 8.2%, P < 0.001). The rate of positive fungal cultures was low in both groups (1.5% vs. 1.9%), with no significant difference (P = 1.000). Gram-positive cocci were the most frequently isolated bacterial culture-positive grafts (53/69, 76.8%). Recipient characteristics by eye bank location The clinical characteristics of the 499 corneal graft recipients are shown in Table 2 . There were no significant differences between the domestic and overseas groups in recipient age (mean 68.0 ± 17.0 vs. 70.4 ± 14.1 years; P = 0.383), sex (P = 0.581), or laterality (P = 0.510). The distribution of preoperative diagnoses differed significantly between the groups (P < 0.001); bullous keratopathy (BK) was the most common indication in the overseas group (57.3%), whereas corneal thinning (38.8%) and opacity (35.1%) were more prevalent in the domestic group. Surgical procedures also differed significantly (P < 0.001); DMEK was the most common procedure in the overseas group (41.1%), whereas PKP (36.6%), DALK (27.6%), and LKP (31.3%) were predominant in the domestic group. There were no significant differences in the prevalence of glaucoma (P = 0.961), diabetes mellitus (P = 0.843), hypertension (P = 0.623), and heart disease (P = 0.960) between the two groups. Post-keratoplasty endophthalmitis occurred in 3 cases (0.6%), all in recipients of overseas grafts, with no significant difference between the groups (P = 0.690; Table 3 ). Characteristics associated with post-keratoplasty endophthalmitis The donors of the three grafts associated with post-keratoplasty endophthalmitis were significantly younger (mean 56.0 ± 1.0 years) than those without endophthalmitis (mean 69.2 ± 12.9 years; P = 0.017). Among the donors of endophthalmitis-associated grafts, two (66.7%) died of multiple organ failure and one (33.3%) died from trauma, with a significant difference in the distribution of causes of death compared with the non-endophthalmitis group (P = 0.025). All three endophthalmitis cases had positive microbial graft cultures (100.0% vs. 15.1%; P = 0.004) and all three had positive fungal graft cultures (100.0% vs. 1.2%; P < 0.001), whereas none had positive bacterial cultures. Recipients who developed endophthalmitis were significantly older (mean 81.7 ± 1.5 years vs. 69.7 ± 15.0 years; P = 0.049). All three affected recipients were female, and underwent surgery in the left eye. All three patients were diagnosed with BK; two underwent DSAEK, and one underwent DMEK. One patient was treated with a single injection of an antifungal drug (amphotericin B). Another patient required transplanted donor tissue removal as well as the injection of an antifungal drug (amphotericin B). The severe case was treated with pars plana vitrectomy and irrigation with the antifungal drug amphotericin B. Donor characteristics by microbial graft culture results Among 499 corneal grafts, 78 (15.6%) were positive for microbial graft cultures (Table 4 ). Grafts from domestic eye banks had a significantly higher rate of positive microbial cultures (52.6%) than the overall proportion of domestic grafts (P < 0.001). Donors with positive microbial cultures were significantly older (mean 73.6 ± 15.7 years vs. 68.3 ± 12.2 years; P < 0.001). Racial distribution differed significantly between the culture-positive and culture-negative groups (P < 0.001), with Asian donors comprising 55.1% and 23.5% of the positive and negative groups, respectively. There were no significant differences in donor sex (P = 0.160), cause of death (P = 0.958), hypertension (P = 0.981), diabetes mellitus (P = 0.320), dyslipidemia (P = 0.938), or graft preparation time (P = 0.496) between the two groups. Donor characteristics by fungal graft culture results Only 9 of the 499 grafts (1.8%) had positive fungal cultures. There were no significant differences between the fungal culture-positive and culture-negative groups in terms of eye bank location (P = 1.000), donor age (P = 0.339), donor sex (P = 0.093), race (P = 0.966), cause of death (P = 0.075), hypertension (P = 0.453), diabetes mellitus (P = 0.616), dyslipidemia (P = 0.455), or graft preparation time (P = 0.230). Among the nine fungal culture-positive patients, seven (77.8%) were female, and multiple organ failure was the most common cause of death (4/9, 44.4%). Donor characteristics by bacterial graft culture results Among the 499 grafts, 69 (13.8%) had positive bacterial cultures. Grafts from domestic eye banks were significantly overrepresented in the positive group (56.5% domestic vs. 22.1% negative group; P < 0.001). Donors with positive bacterial cultures were significantly older (mean 74.7 ± 15.5 years vs. 68.2 ± 12.2 years; P < 0.001), and the racial distribution differed significantly (P < 0.001), with Asian donors comprising 59.4% of the positive group compared with 23.5% of the negative group. There were no significant differences in terms of donor sex (P = 0.484), cause of death (P = 0.784), hypertension (P = 0.856), diabetes mellitus (P = 0.533), dyslipidemia (P = 0.916), or graft preparation time (P = 0.771) between the two groups. Risk factor analysis for graft culture positivity Logistic regression analysis for microbial graft culture positivity revealed that overseas eye bank origin was significantly associated with a lower risk of positive microbial culture in both univariate (OR = 0.256; 95% CI: 0.155–0.422; P < 0.001) and multivariate (OR = 0.259; 95% CI: 0.139–0.486; P < 0.001) models (Table 5 ). Donor age (per 10-year increment) was a significant risk factor in the univariate model (OR = 1.385; 95% CI: 1.143–1.686; P = 0.001), but lost significance after adjusting for eye bank location in the multivariable model (OR = 1.007; 95% CI: 0.812–1.266; P = 0.952). Logistic regression analysis for bacterial graft culture positivity revealed that overseas eye bank origin was similarly associated with a significantly lower risk in both univariate (OR = 0.218; 95% CI: 0.128–0.369; P < 0.001) and multivariate models (OR = 0.238; 95% CI: 0.123–0.465; P < 0.001). Donor age (per 10-year increment) was a significant risk factor in the univariate analysis (OR = 1.496; 95% CI: 1.220–1.843; P < 0.001), but lost significance after adjusting for eye bank location in the multivariable model (OR = 1.052; 95% CI: 0.839–1.346; P = 0.672). Discussion In this study, donor corneas obtained from domestic eye banks were significantly more likely to have positive microbial cultures than those obtained from overseas eye banks. The most frequently detected organisms were bacterial species, particularly gram-positive cocci such as Staphylococcus epidermidis . Because the preservation medium used for donor corneas was identical (Optisol-GS) in both domestic and overseas donors, differences in storage media were unlikely to explain this finding. One possible explanation may be related to differences in donor characteristics. In Japan, donors tend to be older and older individuals are generally more likely to receive antimicrobial therapy during hospitalization, particularly in the presence of multiple comorbidities. [ 15 , 16 ] Such exposure could theoretically influence the microbial flora of donor tissues. However, in the present study, although donor age was associated with microbial contamination in the univariate analysis, this association was no longer significant after adjusting for eye bank location in the multivariate model. These findings suggest that donor age alone is unlikely to account for the higher contamination rates observed in domestic donor corneas. Additionally, antimicrobial exposure was not directly assessed in this study; therefore, this hypothesis remains speculative and should be interpreted with caution. Another possible explanation is related to differences in eye-bank systems and tissue procurement practices. [ 1 , 6 ] In the U.S., donor tissues are typically recovered by trained eye bank technicians within a relatively short postmortem interval through a well-established nationwide network. [ 6 ] In contrast, donor procurement in Japan is often managed by regional eye banks, and variations in the retrieval environment, handling procedures, and transportation logistics may influence microbial contamination. [ 1 , 17 ] Although these factors were not directly evaluated in the present study, they may have partially contributed to the higher rate of bacterial contamination observed in the corneas of domestic donors. [ 10 , 17 ] Standardization of tissue procurement and preservation protocols, along with the development of effective strategies to prevent fungal contamination, may improve the safety of corneal transplantation. Interestingly, the rate of fungal contamination did not differ significantly between domestic and overseas donor corneas. Commonly used corneal preservation media, including Optisol-GS, contain antibacterial agents, but lack antifungal components. [ 18 ] If differences in contamination were primarily due to variations in procurement techniques or handling conditions, both bacterial and fungal contamination rates might differ between the groups. However, this was not observed in this study. In addition, the relatively low number of fungus-positive cases in this study may have limited the statistical power to detect differences between the groups. Therefore, the findings should be interpreted with caution. In our cohort, postoperative endophthalmitis was rare; however, all cases occurred in grafts with positive fungal cultures, and the causative organisms matched those identified in the donor corneal cultures, which is consistent with previous clinical reports. [ 6 , 10 , 14 ] Fungal endophthalmitis is associated with poor visual outcomes. Previous studies have reported that approximately 6.7% of corneas with positive fungal cultures develop postoperative fungal endophthalmitis. [ 10 , 14 ] Once a fungal infection occurs, the clinical course can be devastating, as illustrated in Fig. 1 . However, the number of endophthalmitis cases in this study was small and definitive conclusions regarding causality could not be drawn. The use of povidone-iodine during tissue procurement has been proposed to reduce microbial contamination, with increased exposure time potentially reducing the rate of positive fungal donor rim cultures. [ 19 ] In addition, antimicrobial effects have been reported even at low concentrations of povidone-iodine. [ 20 , 21 ] However, concerns remain regarding their potential toxicity to the corneal endothelial cells. While some studies have suggested that low concentrations of iodine are safe, others have reported endothelial damage even at low concentrations, and no consensus has been established. [ 22 – 24 ] These conflicting findings highlight the need for careful optimization of both concentration and exposure time in clinical practice. More recently, antifungal supplementation of corneal preservation media was investigated as an alternative strategy. Several studies have reported that the addition of antifungal agents such as amphotericin B significantly reduces fungal contamination rates. [ 10 , 18 , 25 ] However, concerns remain regarding the potential toxicity to donor endothelial cells, optimal drug concentration, cost-effectiveness, and actual impact on postoperative infection rates. [ 10 , 25 , 26 ] Furthermore, the resistance profiles of the isolated microorganisms were not evaluated in the present study; therefore, the potential role of antimicrobial-resistant organisms remains unclear. Further investigation is required to determine the clinical utility and safety of antifungal supplementation in corneal preservation media, especially as not all microbial contaminants appear to have equal clinical significance. This study has several limitations. First, this was a retrospective study conducted at a single institution, which may limit generalizability. Second, microbiological evaluation was based on donor corneoscleral rim cultures, which may not fully reflect the true microbial burden within the donor tissue, resulting in false-negative results. Third, important factors, such as detailed preservation conditions, transportation time, and perioperative antimicrobial prophylaxis, were not fully assessed. Fourth, a substantial proportion of donor clinical variables, particularly comorbidities, were categorized as “unknown,” particularly in the domestic cohort. This likely reflects differences in data availability and documentation practices between eye bank systems, rather than random missingness. Although such incomplete data may have limited the ability to fully evaluate certain donor-related risk factors, key findings, including the association between eye bank location and microbial contamination, remained robust in the multivariable analysis. Therefore, the impact of missing data on the primary conclusions of this study was limited. This marked imbalance in data availability between the groups should be considered when interpreting donor comorbidity data. Finally, the number of postoperative endophthalmitis cases was small, limiting the statistical power to evaluate associations with clinical outcomes. In conclusion, although donor corneas from Japanese eye banks showed higher rates of microbial contamination, particularly bacterial contamination, this did not increase the incidence of postoperative endophthalmitis. In contrast, endophthalmitis was exclusively associated with fungal contamination, suggesting that fungal pathogens may play a key role in clinically significant infections after keratoplasty. Declarations Acknowledgments We thank Dr. Sawa M for his valuable advice on this study, Dr. OdaE, PhD (StatLink Consulting) for his statistical support in revising the tables, figures, and manuscript, andDr. Yuda K, MD, PhD (Kikuna Yuda Eye Clinic) for providing the clinical data and valuable support for this study. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Competing interests The authors declare no competing interests. Author contributions All authors contributed to the conception and design of this study. N.N. was the clinical investigator who contributed to data collection, mainly in writing this paper. Y.Y., A.I., M.T., and Y.M. were clinical investigators and critically reviewed the study proposal. H.N. and S.Y. were the participating investigators and critically reviewed the study proposal. T.H. was the clinical investigator, organized all corneal operations included in this study, and critically reviewed the research content. All authors reviewed the manuscript. Data availability statement The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Gain, P. et al. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 134 , 167–173 (2016). Cheng, S. et al. Global trends and prospects of endothelial keratoplasty from 2004 to 2023: a bibliometric analysis. Ann. Med. Surg. (Lond) . 87 , 5892–5905 (2025). Godefrooij, D. A., Gans, R., Imhof, S. M. & Wisse, R. P. Trends in penetrating and anterior lamellar corneal grafting techniques for keratoconus: a national registry study. Acta Ophthalmol. 94 , 489–493 (2016). Patel, S. V. et al. Incidence of endophthalmitis after corneal transplantation or cataract surgery in a Medicare population. Ophthalmology 121 , 290–298 (2014). Taban, M., Behrens, A., Newcomb, R. L., Nobe, M. Y. & McDonnell, P. J. Incidence of acute endophthalmitis following penetrating keratoplasty: a systematic review. Arch. Ophthalmol. 123 , 605–609 (2005). Aldave, A. J. et al. Report of the Eye Bank Association of America Medical Advisory Board Subcommittee on fungal infection after corneal transplantation. Cornea 32 , 149–154 (2013). Terry, M. A. et al. Donor, recipient, and operative factors associated with graft success in the cornea Preservation Time Study. Ophthalmology 125 , 1700–1709 (2018). Wagoner, M. D., Al-Swailem, S. A., Sutphin, J. E. & Zimmerman, M. B. Bacterial keratitis after penetrating keratoplasty: incidence, microbiological profile, graft survival, and visual outcome. Ophthalmology 114 , 1073–1079 (2007). Chen, J. Y. et al. Endophthalmitis after penetrating keratoplasty. Ophthalmology 122 , 25–30 (2015). Vislisel, J. M. et al. Incidence and outcomes of positive donor corneoscleral rim fungal cultures after keratoplasty. Ophthalmology 124 , 36–42 (2017). Thomas, P. A. & Kaliamurthy, J. Mycotic keratitis: epidemiology, diagnosis and management. Clin. Microbiol. Rev. 26 , 557–589 (2013). Menard, M. et al. Microbial profile and clinical outcomes of fungal keratitis at a single-center tertiary care hospital. Clin. Ophthalmol. 16 , 389–399 (2022). Tan, D. T., Dart, J. K., Holland, E. J. & Kinoshita, S. Corneal transplantation. Lancet 379 , 1749–1761 (2012). Keyhani, K., Seedor, J. A., Shah, M. K., Terraciano, A. J. & Ritterband, D. C. The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty. Cornea 24 , 288–291 (2005). OECD. Health at a Glance 2025: OECD Indicators (OECD, 2025). van Buul, L. W. et al. Antibiotic prescribing in long-term care facilities: a systematic review of prevalence, patterns, and appropriateness. J. Am. Med. Dir. Assoc. 13 , 568e1–568e13 (2012). Lee, W. B. et al. Donor rim cultures in corneal transplantation and their clinical significance. Cornea 34 , 122–126 (2015). Romano, V. et al. Impact of storage media on microbial contamination of donor corneas. Cornea 37 , 122–126 (2018). Salisbury, C. D. et al. Increasing povidone-iodine exposure in endothelial keratoplasty tissue processing and fungal infection impact. Cornea 38 , 1093–1096 (2019). Speaker, M. G. & Menikoff, J. A. Prophylaxis of endophthalmitis with topical povidone-iodine. Ophthalmology 98 , 1769–1775 (1991). Machida, Y. et al. Intravitreal povidone-iodine injection and low-dose antibiotic irrigation for infectious endophthalmitis: A retrospective case series. Pharmaceutics 17 , 995 (2025). Naor, J., Savion, N., Blumenthal, M. & Assia, E. I. Corneal endothelial cytotoxicity of diluted povidone-iodine. J. Cataract Refract. Surg. 27 , 941–947 (2001). ElKitkat, R. S. et al. Safety of intracameral injection of minimal bactericidal concentration of povidone-iodine. J Ocul Pharmacol. Ther (2016). Shimada, H., Nakashizuka, H. & Hattori, T. Cataract surgery by intraoperative surface irrigation with 0.25% povidone-iodine. J. Clin. Med. 10 , 3611 (2021). Ritterband, D. C. et al. Antifungal supplementation of corneal storage media reduces fungal contamination. Cornea 26 , 662–665 (2007). Lass, J. H. et al. An evaluation of corneal preservation media. Ophthalmology 97 , 1487–1493 (1990). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 05 May, 2026 Editor assigned by journal 29 Apr, 2026 Editor invited by journal 23 Apr, 2026 Submission checks completed at journal 21 Apr, 2026 First submitted to journal 21 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9439199","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":635541343,"identity":"733730eb-ca0e-4e14-bd04-aca8937fef46","order_by":0,"name":"Naoya Nakagawa","email":"","orcid":"","institution":"Nihon University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Naoya","middleName":"","lastName":"Nakagawa","suffix":""},{"id":635541344,"identity":"4098d22d-7753-466c-bebb-c41f2553055c","order_by":1,"name":"Yuto Yukari","email":"","orcid":"","institution":"Nihon University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuto","middleName":"","lastName":"Yukari","suffix":""},{"id":635541345,"identity":"4446d159-22b7-435f-abec-545d7e21765e","order_by":2,"name":"Ami Igarashi","email":"","orcid":"","institution":"Nihon University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ami","middleName":"","lastName":"Igarashi","suffix":""},{"id":635541346,"identity":"1766057a-13df-4c30-88cf-9582639d8f5d","order_by":3,"name":"Masato Takeda","email":"","orcid":"","institution":"Yokohama Minami Kyosai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Masato","middleName":"","lastName":"Takeda","suffix":""},{"id":635541347,"identity":"0018838a-1fb5-4257-b41a-eb334b50f965","order_by":4,"name":"Yuki Mizuki","email":"","orcid":"","institution":"Yokohama City University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuki","middleName":"","lastName":"Mizuki","suffix":""},{"id":635541348,"identity":"20e4743c-76dc-4401-819e-a198b7410525","order_by":5,"name":"Hiroyuki Nakashizuka","email":"","orcid":"","institution":"Nihon University School of Medicine, Nihon University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Nakashizuka","suffix":""},{"id":635541349,"identity":"feafdc8e-9cbc-4ea4-9afd-088f78166f21","order_by":6,"name":"Satoru Yamagami","email":"","orcid":"","institution":"Nihon University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Satoru","middleName":"","lastName":"Yamagami","suffix":""},{"id":635541350,"identity":"65d6d611-44a3-4a94-9fb3-ba70c931df12","order_by":7,"name":"Takahiko Hayashi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYFACNhDBLAciDzwgRgMPVIsxWEsCKVoSG0AUUVrs2Y8lfrpRYZ0+P+zwQ6AtdnK6DYRs4Uk7LJ1zJj134+00A6CWZGOzAwQdlt4gndt2OHfj7ASQlgOJ2whq4X/e/Dv33+F0w9npH4jUIpF2TDq34XCCvHQOsbbceJZmnXMs3XCDdE7BgQQDIvzC3p9mfDunxlpefnb65g8fKuzkCGqBAwOwSgNilYOAfAMpqkfBKBgFo2BEAQDr40TLAPcAeAAAAABJRU5ErkJggg==","orcid":"","institution":"Nihon University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Takahiko","middleName":"","lastName":"Hayashi","suffix":""}],"badges":[],"createdAt":"2026-04-16 14:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9439199/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9439199/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109216201,"identity":"50bbb2af-4414-4dc9-bc2c-1529f9cbd5f6","added_by":"auto","created_at":"2026-05-13 18:03:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":304762,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA representative case of donor-related fungal infection.\u003c/strong\u003e (\u003cstrong\u003ea\u003c/strong\u003e) A slit lamp photograph indicating an onset of interface fungal infection 17 days after DMEK. (\u003cstrong\u003eb\u003c/strong\u003e) Anterior segment optical coherence tomography showing infiltration to the posterior surface, indicating fungal infection (arrows). Furthermore, \u003cem\u003eCandida albicans\u003c/em\u003e was detected by a microbiological test. (\u003cstrong\u003ec\u003c/strong\u003e) Significant deterioration 1 month post-DMEK, with a substantial amount of hypopyon. (\u003cstrong\u003ed\u003c/strong\u003e) Following DMEK graft removal, anterior chamber irrigation with antifungal drug.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9439199/v1/9778d69e479d8bde854289d5.png"},{"id":109216203,"identity":"3a21373e-bd52-41f8-920e-55f89e1d8bfb","added_by":"auto","created_at":"2026-05-13 18:03:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1011129,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9439199/v1/5574ac85-eaca-431e-9c12-cfc375460347.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Microbial Contamination of Donor Corneas and Post-keratoplasty Endophthalmitis: A Comparison Between Japanese and U.S. Eye Banks Using Cold Storage","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCorneal transplantation is widely performed as an effective treatment for corneal endothelial disorders, corneal opacity, and hereditary corneal diseases. According to a global survey, more than 180,000 corneal transplantations are performed annually. Recent advances in surgical techniques have led to the development of less invasive corneal transplantation procedures, including deep anterior lamellar keratoplasty (DALK), Descemet's stripping automated endothelial keratoplasty (DSAEK), Descemet\u0026rsquo;s membrane endothelial keratoplasty (DMEK), and conventional penetrating keratoplasty (PKP), increasing the number of procedures performed worldwide.\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e However, postoperative infectious complications remain a significant concern, with an incidence of infections such as keratitis or endophthalmitis following corneal transplantation known to be higher than that associated with other intraocular surgeries.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e Reports from the Eye Banking Association of America (EBAA) show an increasing trend in infections following keratoplasty.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e In particular, endophthalmitis, caused by bacterial or fungal infections, often leads to severe visual impairment and poor visual outcomes.\u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVarious microorganisms have been reported as causative pathogens of post-keratoplasty infections, including gram-positive cocci, gram-negative bacilli, and fungi such as \u003cem\u003eCandida, Aspergillus\u003c/em\u003e, and \u003cem\u003eFusarium\u003c/em\u003e.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e Among these, fungal endophthalmitis is particularly difficult to treat and is frequently associated with graft removal, regrafting, and poor visual prognosis.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e In addition, previous studies have demonstrated that donor-related factors play important roles in the development of postoperative infections. Positive donor corneoscleral rim cultures are reported in approximately 7\u0026ndash;15% of cases and may be associated with an increased risk of postoperative infection.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral risk factors for post-keratoplasty infection have been reported, including donor-related factors, preservation conditions of the donor tissue, and the interval between tissue procurement and transplantation. Previous studies have also suggested that contamination of donor corneas with bacteria or fungi may increase the risk of postoperative infection.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite these findings, it remains unclear whether microbial contamination rates differ between eye bank systems across countries and whether such differences translate into clinically relevant infection risks. While eye bank practices, including donor selection, tissue procurement, and handling procedures, vary substantially between regions and may influence microbial contamination of donor tissues, direct comparisons between domestic and international eye banks under similar clinical conditions are limited.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to compare the prevalence and microbial spectrum of donor corneoscleral rim contamination between Japanese and U.S. eye banks and to evaluate its association with postoperative infection following keratoplasty.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patients\u003c/h2\u003e \u003cp\u003e This study was approved by the Institutional Review Board of Nihon University Hospital (approval no. RK-230411-8), and adhered to the tenets of the Declaration of Helsinki. All patients provided informed consent in the form of opto-outs on the website. Patients who refused to participate were excluded.\u003c/p\u003e \u003cp\u003eThe retrospective study population comprised eyes that underwent keratoplasty at Yokohama Minami Kyosai Hospital and the Kikuna Yuda Eye Clinic between April 2015, and September 2021. Surgical procedures included PKP, lamellar keratoplasty (LKP), DALK, DMEK, and DSAEK. All corneal transplantation procedures were performed by a single surgeon (T.H.).\u003c/p\u003e \u003cp\u003eClinical data were accessed and analyzed by investigators who were formally approved Institutional Review Board members or collaborators between May 1, 2025, and December 31, 2025. Data sharing across institutions was conducted in a fully anonymized manner, and no personally identifiable information was accessible to the investigators outside the institution of origin.\u003c/p\u003e \u003cp\u003eDonor corneas were obtained from domestic eye banks in Japan (Chiba, Saitama, Osaka, Toyama, Gifu, Kanagawa, Gunma, Nagasaki, Nagano, and Shizuoka) and overseas eye banks (CorneaGen, Lions Eye Institute, Mid-America Transplant, and Cincinnati Eye Bank). All donor corneas were preserved in Optisol-GS storage medium (Bausch and Lomb) under standard hypothermic conditions.\u003c/p\u003e \u003cp\u003eAt the time of surgery, a portion of the donor corneoscleral rim was aseptically obtained before transplantation and transferred to a sterile transport container (under anaerobic conditions when required) for microbiological culture.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMicrobiological examination\u003c/h3\u003e\n\u003cp\u003eThe collected donor corneal specimens were aseptically divided and inoculated into four types of culture media: CHROMagar Candida Plus agar, Brucella HK agar, sheep blood agar, and chocolate II agar.\u003c/p\u003e \u003cp\u003eFor bacterial detection, cultures were incubated aerobically at 35\u0026deg;C for 72 h. Agar plates were examined at 24-h intervals for colony formation. When bacterial colonies were observed, the organisms were sub-cultured on sheep blood agar for isolation and subsequently identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) according to standard laboratory protocols.\u003c/p\u003e \u003cp\u003eFor fungal detection, colonies observed on CHROMagar Candida Plus agar were sub-cultured on potato dextrose agar and incubated under appropriate conditions to promote fungal growth. Fungal species were identified based on the colony morphology and microscopic examination using lactophenol cotton blue staining.\u003c/p\u003e \u003cp\u003eBrucella HK agar was used for the detection of anaerobic bacteria under anaerobic conditions. Donor corneas in which bacterial or fungal organisms were detected were defined as culture-positive. Bacterial and fungal contaminations were analyzed separately. All microbiological procedures were performed in accordance with standard clinical microbiology laboratory guidelines.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eClinical variables were collected for both recipients and donors. Recipient variables included age, sex, preoperative diagnosis, surgical procedure, medical history (diabetes mellitus, hypertension, dyslipidemia, and heart disease), and use of anticoagulant medications. Donor variables included donor age, donor sex, cause of death, donor medical history (hypertension, diabetes mellitus, and dyslipidemia), and interval between donor death and graft preparation (preservation time).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe demographic and clinical characteristics of corneal graft donors from domestic and overseas eye banks were compared (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Continuous variables, including donor age and graft preparation time, were summarized as mean (standard deviation [SD]) and median [range] and compared using the Wilcoxon rank-sum test. Categorical variables, including donor sex, race, cause of death, hypertension, diabetes mellitus, dyslipidemia, microbial culture results, fungal culture results, bacterial culture results, and bacterial species, were summarized as frequencies and percentages and compared using Pearson\u0026rsquo;s chi-square test. Race categories were based on eye bank\u0026ndash;provided classifications.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of corneal graft donors by eye bank location\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem [unit]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;499)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLocation of eye bank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003cp\u003e[1] vs. [2]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[1] Domestic\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;134)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[2] Overseas\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;365)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor age [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.1 (12.9), 499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.5 (13.6), 134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64.6 (9.1), 365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0 [15, 102]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.0 [15, 102]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66.0 [21, 101]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e275 (55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71 (53.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e204 (55.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.670\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222 (44.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e160 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Caucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e320 (87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (28.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e133 (99.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] Native American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Multiple organ failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] Respiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] Old age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[8] Trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e147 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e210 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e208 (57.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e119 (88.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e259 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.379\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e119 (88.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e241 (66.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e114 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e119 (88.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDeath to preparation\u003c/p\u003e \u003cp\u003e[h]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.01 (5.50), 427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.99 (5.73), 102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.64 (5.28), 325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00 [1.5, 23.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.32 [1.5, 23.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.62 [2.8, 23.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrobial culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e421 (84.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93 (69.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e328 (89.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungal culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e490 (98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e132 (98.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e358 (98.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacterial culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e430 (86.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95 (70.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e335 (91.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacterial species\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] gpc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] gpr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] gnr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] gpc\u0026thinsp;+\u0026thinsp;gnr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] gnr\u0026thinsp;+\u0026thinsp;gnr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] gnr\u0026thinsp;+\u0026thinsp;gpr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] gpc\u0026thinsp;+\u0026thinsp;gpr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eContinuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson\u0026rsquo;s chi-squared test. Participants with missing or unknown data were excluded from analysis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003egpc, gram-positive cocci; gpr, gram-positive rods; gnr, gram-negative rods; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe clinical characteristics of corneal graft recipients from domestic and overseas eye banks were compared (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Continuous variables including recipient age were compared using the Wilcoxon rank-sum test. Categorical variables, including recipient sex, laterality, preoperative diagnosis, surgical procedure, glaucoma, diabetes mellitus, hypertension, heart disease, and occurrence of post-keratoplasty endophthalmitis, were compared using Pearson\u0026rsquo;s chi-squared test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of corneal graft recipients by eye bank location\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem [unit]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;499)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLocation of eye bank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003cp\u003e[1] vs. [2]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[1] Domestic\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;134)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[2] Overseas\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;365)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient age [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.8 (14.9), 492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.0 (17.0), 131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.4 (14.1), 361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.0 [6, 91]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.0 [6, 89]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74.0 [17, 91]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225 (45.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e168 (46.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e196 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight or left eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Right\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e262 (52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e188 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Left\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e175 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] BK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225 (45.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e209 (57.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Opacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Failed KP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Corneal thinning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] KC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] DMEK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e150 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] PKP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125 (25.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49 (36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] DALK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] DSAEK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] LKP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEndophthalmitis\u003c/p\u003e \u003cp\u003eafter transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e496 (99.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e362 (99.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eContinuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson\u0026rsquo;s chi-squared test. Participants with missing or unknown data were excluded from analysis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBK, bullous keratopathy; KP, keratoplasty; KC, keratoconus; DMEK, Descemet\u0026rsquo;s membrane endothelial keratoplasty; PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; DSAEK, Descemet\u0026rsquo;s stripping automated endothelial keratoplasty; LKP, lamellar keratoplasty; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDonor and recipient characteristics were compared between patients with and without post-keratoplasty endophthalmitis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Given the small number of endophthalmitis cases, continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of donors and recipients with or without post-keratoplasty endophthalmitis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem [unit]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePost-keratoplasty\u003c/p\u003e \u003cp\u003eendophthalmitis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003cp\u003e[1] vs. [2]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;496)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEye bank location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Domestic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Overseas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e362 (73.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor age [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.2 (12.9), 496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.0 (1.0), 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.0 [15, 102]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.0 [55, 57]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e274 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Caucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e318 (64.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] Native American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor cause of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Multiple organ failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] Respiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] Old age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[8] Trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158 (31.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e209 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e269 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.569\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (19.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor dyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath to preparation [h]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.01 (5.51), 426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.55 (NA), 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.03 [1.5, 23.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.55 [8.6, 8.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrobial culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e421 (84.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungal culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e490 (98.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacterial culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e427 (86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient, Age [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.7 (15.0), 489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.7 (1.5), 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.0 [6, 91]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.0 [80, 83]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient, Sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225 (45.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e269 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight or left eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Right\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e262 (52.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Left\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e231 (46.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] BK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Opacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Failed KP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Corneal thinning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] KC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] DMEK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] PKP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] DALK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] DSAEK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] LKP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient glaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e489 (98.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e466 (94.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e488 (98.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecipient heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e476 (96.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eContinuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Fisher\u0026rsquo;s exact test. Participants with missing or unknown data were excluded from analysis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBK, bullous keratopathy; KP, keratoplasty; KC, keratoconus; DMEK, Descemet\u0026rsquo;s membrane endothelial keratoplasty; PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; DSAEK, Descemet\u0026rsquo;s stripping automated endothelial keratoplasty; LKP, lamellar keratoplasty; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDonor characteristics were stratified according to microbial graft culture results (positive vs. negative) to identify potential factors associated with graft contamination (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson\u0026rsquo;s chi-squared test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of donors stratified by microbial graft culture results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem [unit]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMicrobial graft culture\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003cp\u003e[1] vs. [2]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[1] Negative\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;421)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[2] Positive\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEye bank location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Domestic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Overseas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e328 (77.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor age [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.3 (12.2), 421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.6 (15.7), 78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0 [16, 102]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.5 [15, 97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181 (43.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Caucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e290 (68.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43 (55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] Native American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor cause of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Multiple organ failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[4] Stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[5] Respiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[6] Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[7] Old age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[8] Trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (21.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e241 (57.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor dyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229 (54.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[3] Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath to preparation [h]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD), N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.06 (5.42), 365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.68 (5.98), 62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.05 [1.6, 23.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.97 [1.5, 23.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eContinuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Pearson\u0026rsquo;s chi-squared test. Participants with missing or unknown data were excluded from analysis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLogistic regression analysis was used to identify independent risk factors for microbial graft culture positivity (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Eye bank location and donor age (per 10-year increment) were included as explanatory variables. Both univariate and multivariate models were fitted, and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Variables with missing or unavailable data were categorized as \u0026ldquo;unknown\u0026rdquo; and included in the analysis where appropriate.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk factor analysis for microbial graft culture positivity using logistic regression model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExplanatory variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003cp\u003eUnit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eUnivariable model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eMultivariable model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEye bank location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[1] Domestic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[2] Overseas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[0.155, 0.422]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[0.139, 0.486]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonor age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[1.143, 1.686]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e[0.812, 1.266]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eCI, confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using a two-sided significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Participants with missing or unknown data were excluded from analysis. All statistical analyses were performed using R version 4.5.1 (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDonor characteristics by eye bank location\u003c/h2\u003e \u003cp\u003eAmong 499 corneal grafts included in this study, 134 (26.9%) were obtained from domestic eye banks and 365 (73.1%) from overseas eye banks (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean donor age was significantly higher in the domestic group (81.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6 years) compared with the overseas group (64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 years; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was no significant difference in the donor sex between the two groups (P\u0026thinsp;=\u0026thinsp;0.670). The racial composition differed significantly between the groups; domestic donors were predominantly Asian (99.3%), whereas overseas donors were predominantly Caucasian (87.7%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The distribution of causes of death also differed significantly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with infection (20.1%) and old age (15.7%) being more common among domestic donors, whereas heart disease (27.4%) and cancer (26.0%) were more prevalent among overseas donors. Among donors with available comorbidity data, hypertension (P\u0026thinsp;=\u0026thinsp;0.001) and dyslipidemia (P\u0026thinsp;=\u0026thinsp;0.019) were significantly more common in the overseas group, whereas diabetes mellitus showed no significant difference (P\u0026thinsp;=\u0026thinsp;0.379). The mean graft preparation time was significantly shorter for domestic grafts (8.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73 h) than for overseas grafts (11.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28 h; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The overall rate of positive microbial cultures was 15.6%, which was significantly higher in the domestic group (30.6%) than that in the overseas group (10.1%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, the rate of positive bacterial cultures was significantly higher in the domestic group (29.1% vs. 8.2%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The rate of positive fungal cultures was low in both groups (1.5% vs. 1.9%), with no significant difference (P\u0026thinsp;=\u0026thinsp;1.000). Gram-positive cocci were the most frequently isolated bacterial culture-positive grafts (53/69, 76.8%).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecipient characteristics by eye bank location\u003c/h3\u003e\n\u003cp\u003eThe clinical characteristics of the 499 corneal graft recipients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no significant differences between the domestic and overseas groups in recipient age (mean 68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.0 vs. 70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1 years; P\u0026thinsp;=\u0026thinsp;0.383), sex (P\u0026thinsp;=\u0026thinsp;0.581), or laterality (P\u0026thinsp;=\u0026thinsp;0.510). The distribution of preoperative diagnoses differed significantly between the groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); bullous keratopathy (BK) was the most common indication in the overseas group (57.3%), whereas corneal thinning (38.8%) and opacity (35.1%) were more prevalent in the domestic group. Surgical procedures also differed significantly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); DMEK was the most common procedure in the overseas group (41.1%), whereas PKP (36.6%), DALK (27.6%), and LKP (31.3%) were predominant in the domestic group. There were no significant differences in the prevalence of glaucoma (P\u0026thinsp;=\u0026thinsp;0.961), diabetes mellitus (P\u0026thinsp;=\u0026thinsp;0.843), hypertension (P\u0026thinsp;=\u0026thinsp;0.623), and heart disease (P\u0026thinsp;=\u0026thinsp;0.960) between the two groups. Post-keratoplasty endophthalmitis occurred in 3 cases (0.6%), all in recipients of overseas grafts, with no significant difference between the groups (P\u0026thinsp;=\u0026thinsp;0.690; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eCharacteristics associated with post-keratoplasty endophthalmitis\u003c/h3\u003e\n\u003cp\u003eThe donors of the three grafts associated with post-keratoplasty endophthalmitis were significantly younger (mean 56.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 years) than those without endophthalmitis (mean 69.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9 years; P\u0026thinsp;=\u0026thinsp;0.017). Among the donors of endophthalmitis-associated grafts, two (66.7%) died of multiple organ failure and one (33.3%) died from trauma, with a significant difference in the distribution of causes of death compared with the non-endophthalmitis group (P\u0026thinsp;=\u0026thinsp;0.025). All three endophthalmitis cases had positive microbial graft cultures (100.0% vs. 15.1%; P\u0026thinsp;=\u0026thinsp;0.004) and all three had positive fungal graft cultures (100.0% vs. 1.2%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas none had positive bacterial cultures. Recipients who developed endophthalmitis were significantly older (mean 81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 years vs. 69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0 years; P\u0026thinsp;=\u0026thinsp;0.049). All three affected recipients were female, and underwent surgery in the left eye. All three patients were diagnosed with BK; two underwent DSAEK, and one underwent DMEK. One patient was treated with a single injection of an antifungal drug (amphotericin B). Another patient required transplanted donor tissue removal as well as the injection of an antifungal drug (amphotericin B). The severe case was treated with pars plana vitrectomy and irrigation with the antifungal drug amphotericin B.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDonor characteristics by microbial graft culture results\u003c/h2\u003e \u003cp\u003eAmong 499 corneal grafts, 78 (15.6%) were positive for microbial graft cultures (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Grafts from domestic eye banks had a significantly higher rate of positive microbial cultures (52.6%) than the overall proportion of domestic grafts (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Donors with positive microbial cultures were significantly older (mean 73.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7 years vs. 68.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2 years; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Racial distribution differed significantly between the culture-positive and culture-negative groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with Asian donors comprising 55.1% and 23.5% of the positive and negative groups, respectively. There were no significant differences in donor sex (P\u0026thinsp;=\u0026thinsp;0.160), cause of death (P\u0026thinsp;=\u0026thinsp;0.958), hypertension (P\u0026thinsp;=\u0026thinsp;0.981), diabetes mellitus (P\u0026thinsp;=\u0026thinsp;0.320), dyslipidemia (P\u0026thinsp;=\u0026thinsp;0.938), or graft preparation time (P\u0026thinsp;=\u0026thinsp;0.496) between the two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDonor characteristics by fungal graft culture results\u003c/h2\u003e \u003cp\u003eOnly 9 of the 499 grafts (1.8%) had positive fungal cultures. There were no significant differences between the fungal culture-positive and culture-negative groups in terms of eye bank location (P\u0026thinsp;=\u0026thinsp;1.000), donor age (P\u0026thinsp;=\u0026thinsp;0.339), donor sex (P\u0026thinsp;=\u0026thinsp;0.093), race (P\u0026thinsp;=\u0026thinsp;0.966), cause of death (P\u0026thinsp;=\u0026thinsp;0.075), hypertension (P\u0026thinsp;=\u0026thinsp;0.453), diabetes mellitus (P\u0026thinsp;=\u0026thinsp;0.616), dyslipidemia (P\u0026thinsp;=\u0026thinsp;0.455), or graft preparation time (P\u0026thinsp;=\u0026thinsp;0.230). Among the nine fungal culture-positive patients, seven (77.8%) were female, and multiple organ failure was the most common cause of death (4/9, 44.4%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDonor characteristics by bacterial graft culture results\u003c/h2\u003e \u003cp\u003eAmong the 499 grafts, 69 (13.8%) had positive bacterial cultures. Grafts from domestic eye banks were significantly overrepresented in the positive group (56.5% domestic vs. 22.1% negative group; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Donors with positive bacterial cultures were significantly older (mean 74.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5 years vs. 68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2 years; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the racial distribution differed significantly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with Asian donors comprising 59.4% of the positive group compared with 23.5% of the negative group. There were no significant differences in terms of donor sex (P\u0026thinsp;=\u0026thinsp;0.484), cause of death (P\u0026thinsp;=\u0026thinsp;0.784), hypertension (P\u0026thinsp;=\u0026thinsp;0.856), diabetes mellitus (P\u0026thinsp;=\u0026thinsp;0.533), dyslipidemia (P\u0026thinsp;=\u0026thinsp;0.916), or graft preparation time (P\u0026thinsp;=\u0026thinsp;0.771) between the two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRisk factor analysis for graft culture positivity\u003c/h2\u003e \u003cp\u003eLogistic regression analysis for microbial graft culture positivity revealed that overseas eye bank origin was significantly associated with a lower risk of positive microbial culture in both univariate (OR\u0026thinsp;=\u0026thinsp;0.256; 95% CI: 0.155\u0026ndash;0.422; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and multivariate (OR\u0026thinsp;=\u0026thinsp;0.259; 95% CI: 0.139\u0026ndash;0.486; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) models (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Donor age (per 10-year increment) was a significant risk factor in the univariate model (OR\u0026thinsp;=\u0026thinsp;1.385; 95% CI: 1.143\u0026ndash;1.686; P\u0026thinsp;=\u0026thinsp;0.001), but lost significance after adjusting for eye bank location in the multivariable model (OR\u0026thinsp;=\u0026thinsp;1.007; 95% CI: 0.812\u0026ndash;1.266; P\u0026thinsp;=\u0026thinsp;0.952).\u003c/p\u003e \u003cp\u003eLogistic regression analysis for bacterial graft culture positivity revealed that overseas eye bank origin was similarly associated with a significantly lower risk in both univariate (OR\u0026thinsp;=\u0026thinsp;0.218; 95% CI: 0.128\u0026ndash;0.369; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and multivariate models (OR\u0026thinsp;=\u0026thinsp;0.238; 95% CI: 0.123\u0026ndash;0.465; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Donor age (per 10-year increment) was a significant risk factor in the univariate analysis (OR\u0026thinsp;=\u0026thinsp;1.496; 95% CI: 1.220\u0026ndash;1.843; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but lost significance after adjusting for eye bank location in the multivariable model (OR\u0026thinsp;=\u0026thinsp;1.052; 95% CI: 0.839\u0026ndash;1.346; P\u0026thinsp;=\u0026thinsp;0.672).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, donor corneas obtained from domestic eye banks were significantly more likely to have positive microbial cultures than those obtained from overseas eye banks. The most frequently detected organisms were bacterial species, particularly gram-positive cocci such as \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e. Because the preservation medium used for donor corneas was identical (Optisol-GS) in both domestic and overseas donors, differences in storage media were unlikely to explain this finding.\u003c/p\u003e \u003cp\u003eOne possible explanation may be related to differences in donor characteristics. In Japan, donors tend to be older and older individuals are generally more likely to receive antimicrobial therapy during hospitalization, particularly in the presence of multiple comorbidities.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e Such exposure could theoretically influence the microbial flora of donor tissues. However, in the present study, although donor age was associated with microbial contamination in the univariate analysis, this association was no longer significant after adjusting for eye bank location in the multivariate model. These findings suggest that donor age alone is unlikely to account for the higher contamination rates observed in domestic donor corneas. Additionally, antimicrobial exposure was not directly assessed in this study; therefore, this hypothesis remains speculative and should be interpreted with caution.\u003c/p\u003e \u003cp\u003eAnother possible explanation is related to differences in eye-bank systems and tissue procurement practices.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e In the U.S., donor tissues are typically recovered by trained eye bank technicians within a relatively short postmortem interval through a well-established nationwide network.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e In contrast, donor procurement in Japan is often managed by regional eye banks, and variations in the retrieval environment, handling procedures, and transportation logistics may influence microbial contamination.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e Although these factors were not directly evaluated in the present study, they may have partially contributed to the higher rate of bacterial contamination observed in the corneas of domestic donors.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e Standardization of tissue procurement and preservation protocols, along with the development of effective strategies to prevent fungal contamination, may improve the safety of corneal transplantation.\u003c/p\u003e \u003cp\u003eInterestingly, the rate of fungal contamination did not differ significantly between domestic and overseas donor corneas. Commonly used corneal preservation media, including Optisol-GS, contain antibacterial agents, but lack antifungal components.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e If differences in contamination were primarily due to variations in procurement techniques or handling conditions, both bacterial and fungal contamination rates might differ between the groups. However, this was not observed in this study. In addition, the relatively low number of fungus-positive cases in this study may have limited the statistical power to detect differences between the groups. Therefore, the findings should be interpreted with caution.\u003c/p\u003e \u003cp\u003eIn our cohort, postoperative endophthalmitis was rare; however, all cases occurred in grafts with positive fungal cultures, and the causative organisms matched those identified in the donor corneal cultures, which is consistent with previous clinical reports.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Fungal endophthalmitis is associated with poor visual outcomes. Previous studies have reported that approximately 6.7% of corneas with positive fungal cultures develop postoperative fungal endophthalmitis.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Once a fungal infection occurs, the clinical course can be devastating, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. However, the number of endophthalmitis cases in this study was small and definitive conclusions regarding causality could not be drawn.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe use of povidone-iodine during tissue procurement has been proposed to reduce microbial contamination, with increased exposure time potentially reducing the rate of positive fungal donor rim cultures.\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e In addition, antimicrobial effects have been reported even at low concentrations of povidone-iodine.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e However, concerns remain regarding their potential toxicity to the corneal endothelial cells. While some studies have suggested that low concentrations of iodine are safe, others have reported endothelial damage even at low concentrations, and no consensus has been established.\u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e These conflicting findings highlight the need for careful optimization of both concentration and exposure time in clinical practice.\u003c/p\u003e \u003cp\u003eMore recently, antifungal supplementation of corneal preservation media was investigated as an alternative strategy. Several studies have reported that the addition of antifungal agents such as amphotericin B significantly reduces fungal contamination rates.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e However, concerns remain regarding the potential toxicity to donor endothelial cells, optimal drug concentration, cost-effectiveness, and actual impact on postoperative infection rates.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e Furthermore, the resistance profiles of the isolated microorganisms were not evaluated in the present study; therefore, the potential role of antimicrobial-resistant organisms remains unclear. Further investigation is required to determine the clinical utility and safety of antifungal supplementation in corneal preservation media, especially as not all microbial contaminants appear to have equal clinical significance.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this was a retrospective study conducted at a single institution, which may limit generalizability. Second, microbiological evaluation was based on donor corneoscleral rim cultures, which may not fully reflect the true microbial burden within the donor tissue, resulting in false-negative results. Third, important factors, such as detailed preservation conditions, transportation time, and perioperative antimicrobial prophylaxis, were not fully assessed. Fourth, a substantial proportion of donor clinical variables, particularly comorbidities, were categorized as \u0026ldquo;unknown,\u0026rdquo; particularly in the domestic cohort. This likely reflects differences in data availability and documentation practices between eye bank systems, rather than random missingness. Although such incomplete data may have limited the ability to fully evaluate certain donor-related risk factors, key findings, including the association between eye bank location and microbial contamination, remained robust in the multivariable analysis. Therefore, the impact of missing data on the primary conclusions of this study was limited. This marked imbalance in data availability between the groups should be considered when interpreting donor comorbidity data. Finally, the number of postoperative endophthalmitis cases was small, limiting the statistical power to evaluate associations with clinical outcomes.\u003c/p\u003e \u003cp\u003eIn conclusion, although donor corneas from Japanese eye banks showed higher rates of microbial contamination, particularly bacterial contamination, this did not increase the incidence of postoperative endophthalmitis. In contrast, endophthalmitis was exclusively associated with fungal contamination, suggesting that fungal pathogens may play a key role in clinically significant infections after keratoplasty.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Dr. Sawa M for his valuable advice on this study, Dr. OdaE, PhD (StatLink Consulting) for his statistical support in revising the tables, figures, and manuscript, andDr. Yuda K, MD, PhD (Kikuna Yuda Eye Clinic) for providing the clinical data and valuable support for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of this study. N.N. was the clinical investigator who contributed to data collection, mainly in writing this paper. Y.Y., A.I., M.T., and Y.M. were clinical investigators and critically reviewed the study proposal. H.N. and S.Y. were the participating investigators and critically reviewed the study proposal. T.H. was the clinical investigator, organized all corneal operations included in this study, and critically reviewed the research content. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGain, P. et al. Global survey of corneal transplantation and eye banking. \u003cem\u003eJAMA Ophthalmol.\u003c/em\u003e \u003cb\u003e134\u003c/b\u003e, 167\u0026ndash;173 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng, S. et al. Global trends and prospects of endothelial keratoplasty from 2004 to 2023: a bibliometric analysis. \u003cem\u003eAnn. Med. Surg. (Lond)\u003c/em\u003e. \u003cb\u003e87\u003c/b\u003e, 5892\u0026ndash;5905 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodefrooij, D. A., Gans, R., Imhof, S. M. \u0026amp; Wisse, R. P. Trends in penetrating and anterior lamellar corneal grafting techniques for keratoconus: a national registry study. \u003cem\u003eActa Ophthalmol.\u003c/em\u003e \u003cb\u003e94\u003c/b\u003e, 489\u0026ndash;493 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel, S. V. et al. Incidence of endophthalmitis after corneal transplantation or cataract surgery in a Medicare population. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e121\u003c/b\u003e, 290\u0026ndash;298 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaban, M., Behrens, A., Newcomb, R. L., Nobe, M. Y. \u0026amp; McDonnell, P. J. Incidence of acute endophthalmitis following penetrating keratoplasty: a systematic review. \u003cem\u003eArch. Ophthalmol.\u003c/em\u003e \u003cb\u003e123\u003c/b\u003e, 605\u0026ndash;609 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldave, A. J. et al. Report of the Eye Bank Association of America Medical Advisory Board Subcommittee on fungal infection after corneal transplantation. \u003cem\u003eCornea\u003c/em\u003e \u003cb\u003e32\u003c/b\u003e, 149\u0026ndash;154 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerry, M. A. et al. Donor, recipient, and operative factors associated with graft success in the cornea Preservation Time Study. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e125\u003c/b\u003e, 1700\u0026ndash;1709 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagoner, M. D., Al-Swailem, S. A., Sutphin, J. E. \u0026amp; Zimmerman, M. B. Bacterial keratitis after penetrating keratoplasty: incidence, microbiological profile, graft survival, and visual outcome. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e114\u003c/b\u003e, 1073\u0026ndash;1079 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, J. Y. et al. Endophthalmitis after penetrating keratoplasty. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e122\u003c/b\u003e, 25\u0026ndash;30 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVislisel, J. M. et al. Incidence and outcomes of positive donor corneoscleral rim fungal cultures after keratoplasty. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e124\u003c/b\u003e, 36\u0026ndash;42 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas, P. A. \u0026amp; Kaliamurthy, J. Mycotic keratitis: epidemiology, diagnosis and management. \u003cem\u003eClin. Microbiol. Rev.\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e, 557\u0026ndash;589 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenard, M. et al. Microbial profile and clinical outcomes of fungal keratitis at a single-center tertiary care hospital. \u003cem\u003eClin. Ophthalmol.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e, 389\u0026ndash;399 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan, D. T., Dart, J. K., Holland, E. J. \u0026amp; Kinoshita, S. Corneal transplantation. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e379\u003c/b\u003e, 1749\u0026ndash;1761 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeyhani, K., Seedor, J. A., Shah, M. K., Terraciano, A. J. \u0026amp; Ritterband, D. C. The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty. \u003cem\u003eCornea\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e, 288\u0026ndash;291 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOECD. \u003cem\u003eHealth at a Glance 2025: OECD Indicators\u003c/em\u003e (OECD, 2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Buul, L. W. et al. Antibiotic prescribing in long-term care facilities: a systematic review of prevalence, patterns, and appropriateness. \u003cem\u003eJ. Am. Med. Dir. Assoc.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e, 568e1\u0026ndash;568e13 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee, W. B. et al. Donor rim cultures in corneal transplantation and their clinical significance. \u003cem\u003eCornea\u003c/em\u003e \u003cb\u003e34\u003c/b\u003e, 122\u0026ndash;126 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomano, V. et al. Impact of storage media on microbial contamination of donor corneas. \u003cem\u003eCornea\u003c/em\u003e \u003cb\u003e37\u003c/b\u003e, 122\u0026ndash;126 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalisbury, C. D. et al. Increasing povidone-iodine exposure in endothelial keratoplasty tissue processing and fungal infection impact. \u003cem\u003eCornea\u003c/em\u003e \u003cb\u003e38\u003c/b\u003e, 1093\u0026ndash;1096 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpeaker, M. G. \u0026amp; Menikoff, J. A. Prophylaxis of endophthalmitis with topical povidone-iodine. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e98\u003c/b\u003e, 1769\u0026ndash;1775 (1991).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMachida, Y. et al. Intravitreal povidone-iodine injection and low-dose antibiotic irrigation for infectious endophthalmitis: A retrospective case series. \u003cem\u003ePharmaceutics\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e, 995 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaor, J., Savion, N., Blumenthal, M. \u0026amp; Assia, E. I. Corneal endothelial cytotoxicity of diluted povidone-iodine. \u003cem\u003eJ. Cataract Refract. Surg.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e, 941\u0026ndash;947 (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElKitkat, R. S. et al. Safety of intracameral injection of minimal bactericidal concentration of povidone-iodine. \u003cem\u003eJ Ocul Pharmacol. Ther\u003c/em\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShimada, H., Nakashizuka, H. \u0026amp; Hattori, T. Cataract surgery by intraoperative surface irrigation with 0.25% povidone-iodine. \u003cem\u003eJ. Clin. Med.\u003c/em\u003e \u003cb\u003e10\u003c/b\u003e, 3611 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRitterband, D. C. et al. Antifungal supplementation of corneal storage media reduces fungal contamination. \u003cem\u003eCornea\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e, 662\u0026ndash;665 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLass, J. H. et al. An evaluation of corneal preservation media. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e97\u003c/b\u003e, 1487\u0026ndash;1493 (1990).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"fungal endophthalmitis, corneal transplant, eye banking, donor rim cultures, fortified preservation media, transplant infection","lastPublishedDoi":"10.21203/rs.3.rs-9439199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9439199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study evaluated the prevalence and microbial spectrum of positive corneoscleral donor rim cultures and the associated risk factors for post-keratoplasty infection in Japan. We retrospectively included consecutive corneal transplantations performed by a single surgeon between April 2015 and September 2021. Donor corneas were obtained from eye banks in Japan (n\u0026thinsp;=\u0026thinsp;134) or the United States (n\u0026thinsp;=\u0026thinsp;365) and preserved using cold storage. Donor corneoscleral rim cultures were obtained during surgery. Culture positivity and microbial profiles were analyzed. Risk factors for contamination were evaluated using logistic regression. Overall, 78 (15.6%) were culture-positive. Domestic grafts had significantly higher microbial contamination rates than overseas grafts (30.6% vs. 10.1%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas fungal contamination rates did not differ between groups (1.5% vs. 1.9%, P\u0026thinsp;=\u0026thinsp;1.000). In the multivariate analysis, overseas eye bank origin was independently associated with a lower risk of microbial contamination (OR 0.259, 95% CI, 0.139\u0026ndash;0.486; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post-keratoplasty endophthalmitis occurred in three cases (0.6%), all of which were associated with positive fungal cultures. Therefore, fungal pathogens may play a key role in increasing clinically significant postoperative endophthalmitis risk after keratoplasty, highlighting the importance of targeted donor tissue screening and postoperative management.\u003c/p\u003e","manuscriptTitle":"Microbial Contamination of Donor Corneas and Post-keratoplasty Endophthalmitis: A Comparison Between Japanese and U.S. Eye Banks Using Cold Storage","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 18:02:56","doi":"10.21203/rs.3.rs-9439199/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-05T08:04:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-29T13:51:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-23T04:23:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-21T11:38:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-04-21T11:02:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd9ad2f4-b55b-4b46-be9a-312bdf04a823","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"22","date":"2026-05-05T08:04:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-29T13:51:33+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":67641319,"name":"Health sciences/Diseases"},{"id":67641320,"name":"Health sciences/Medical research"},{"id":67641321,"name":"Biological sciences/Microbiology"},{"id":67641322,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-13T18:02:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 18:02:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9439199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9439199","identity":"rs-9439199","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}