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Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En\/DMT. Relationships between baseline factors and En\/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En\/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En\/DMT and graft status. Outcome measures included\u00a0graft rejection, central Endothelium\/Descemet\u2019s complex thickness, and\u00a0central corneal thickness (CCT). In patients with GR (35%), the central En\/DMT increased significantly 5.3\u00a0months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En\/DMTs (<jats:italic>p<\/jats:italic>\u2009=\u20090.01), compared to CCTs (<jats:italic>p<\/jats:italic>\u2009=\u20090.7). For En\/DMT\u2009\u2265\u200918\u00a0\u00b5m cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; <jats:italic>p<\/jats:italic>\u2009=\u20090.002), and it increased to 9.91 (95% CI: 3.32, 29.6; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) with a \u2265\u200919\u00a0\u00b5m cut-off. In high-risk corneal transplants, the increase in En\/DMT allowed predicting rejection prior to the clinical diagnosis.<\/jats:p>","DOI":"10.1038\/s41598-021-93892-4","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T10:03:50Z","timestamp":1626343430000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prediction of corneal graft rejection using central endothelium\/Descemet\u2019s membrane complex thickness in high-risk corneal transplants"],"prefix":"10.1038","volume":"11","author":[{"given":"Taher","family":"Eleiwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Elsawy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyup","family":"Ozcan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collin","family":"Chase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Feuer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia H.","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor L.","family":"Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed F.","family":"Abou Shousha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"issue":"5","key":"93892_CR1","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/0039-6257(90)90110-H","volume":"34","author":"SE Wilson","year":"1990","unstructured":"Wilson, S. 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Sonia Yoo and Mohamed Abou Shousha: United States Non-Provisional Patents (Application No. 8992023 and 61809518), and PCT\/US2018\/013409. Patents and PCT are owned by University of Miami and licensed to Resolve Ophthalmics, LLC. Mohamed Abou Shousha is equity holder and sits on the Board of Directors for Resolve Ophthalmics, LLC.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"14542"}}