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To identify potential donor, recipient, surgical, and postoperative factors that may influence survival and visual outcome of penetrating keratoplasty (PKP).As part of a prospective longitudinal study, the electronic records of the New Zealand National Eye Bank were analyzed for the 10-year period from 1994-2003. Both univariate and multivariate analysis was performed.During the study period, the New Zealand National Eye Bank supplied 1820 corneas for PKP and 1629 (90%) had 1-year follow-up data. Overall, the 1-year survival rate was 87% (n = 1429). Donor factors including age, donor source, cause of death, death-to-preservation interval, endothelial cell density, donor lens status, and storage duration, were not significantly associated with decreased survival. The leading cause of PKP failure was irreversible rejection (7%, n = 114). Independent risk factors identified for decreased PKP survival were: 1 or more episodes of reversible rejection, active inflammation at PKP, preexisting corneal vascularization, intraoperative complications, small graft size (≤7.25 mm), large graft size (≥8.5 mm), preoperative glaucoma, and a preoperative diagnosis of regraft or trauma. A best-corrected Snellen visual acuity of 6/12 or better was achieved in 60% of eyes [mean: 6/15 (logarithm of the minimum angle of resolution 0.40)]. Keratoconus and Fuchs endothelial dystrophy were the diagnoses with best survival and visual outcome, whereas, bullous keratopathy, trauma or noninfective keratitis were associated with poorer visual outcome.Several independent risk factors were identified that significantly influenced PKP first year survival outcome. This information is valuable to patients and surgeons with respect to determining prognosis and clinical decision making.