{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:07:32Z","timestamp":1788934052469,"version":"build-2803163510"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001505","name":"Health Research Council of New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001505","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001537","name":"University of Auckland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001537","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Ophthalmol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To determine the impact of COVID-19 infection and vaccination on risk of corneal transplant rejection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All corneal transplants performed in Auckland, New Zealand (NZ), between January 2010 and December 2022 were included. Demographic, clinical, and surgical characteristics were recorded, along with COVID-19 vaccination and infection history. Time to corneal transplant rejection was analysed using Weibull survival regression with clustered standard errors at the graft level to account for repeated events and time-varying covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1183 corneal transplants were performed in 926 patients, with a median age of 52\u00a0years (IQR 32\u201370); 47.5% were female. The median follow-up was 11.7\u00a0years\u2009\u00b1\u20093.8. Within 3\u00a0months following COVID-19 vaccination, 1.1% of corneal transplants were rejected; within the same period following COVID-19 infection, 2.3% of transplants rejected. Overall, 277 transplants (23.4%) experienced rejection. On multivariable analysis, COVID-19 vaccination within 3\u00a0months was associated with elevated rejection risk (HR 1.834,\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.012), while COVID-19 infection within 3\u00a0months carried the greatest risk (HR 3.533,\n                      <jats:italic>p\u2009<\/jats:italic>\n                      &lt;\u20090.001). Corneal transplant rejection was associated with significantly worse visual acuity follow-up (rejection median 20\/160, no rejection 20\/70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>COVID-19 vaccination and infection were independently associated with an increased likelihood of corneal transplant rejection, with infection conferring the greatest risk. These findings suggest that systemic immune activation induced by SARS-CoV-2 immunisation may disrupt the delicate balance of transplant immunity and tolerance. This is the first large cohort study demonstrating an independent association between recent COVID-19 infection, vaccination, and increased risk of corneal graft rejection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10792-026-04261-x","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:56:16Z","timestamp":1788933376000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increased risk of corneal transplant rejection following SARS-CoV-2 infection and vaccination"],"prefix":"10.1007","volume":"46","author":[{"given":"Natalie E.","family":"Allen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael L.","family":"Niederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akilesh","family":"Gokul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Casey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Tippett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles N. 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