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Purpose. To assess the results of penetrating keratoplasty and identify the risk factors for the graft disease (GD) development. Material and methods. Data of 582 patients after corneal transplantation performed in the period since 2011 to 2019 for keratoconus (41%), as well for corneal leucorrhoea and dystrophies (59%), aggravated by concomitant pathology, the so-called high-risk keratoplasty (HRK) were analyzed in a retrospective cohort study. We estimated the functional results and incidence of GD. The calculation of the t-criterion; cross-tabulation method; Kaplan–Meier survival analysis and multivariate analysis were applied.Results. As a result of penetrating keratoplasty, the BCVA (best corrected visual acuity) in patients with keratoconus increased by 20%; in patients with HRK – by 8%. In the general group the graft survival rate was 72%, while the 8-year successful graft engraftment in patients with keratoconus comprised 91%, with HRK – 60%. A significant relationship of the GD development with preoperative diagnosis and rekeratoplasty was determined. The risk of GD incidence was minimal in patients under 30 years of age and maximum in patients aged from 50 to 70 years. Survival rates for corneal transplants were better in men than in women.Conclusion. Penetrating keratoplasty in patients with keratoconus provides a good functional result with a minimal risk of GD development. With penetrating keratoplasty in high-risk patients, the effectiveness of surgical interventions is significantly lower (by ~30%).