This UK based study examined long-term descemet stripping endothelial keratoplasty (DSEK) results, looking at graft survival and endothelial cell losses. Data on 210 grafts were included in analysis. Most frequent indication for DSEK was Fuch’s endothelial dystrophy (81.4%) and 46.3% of transplants were performed in combination with phacoemulsification. Seven eyes failed during follow-up as a result of late endothelial decompensation occurring between one year and five years after surgery. Five-year cumulative graft survival was 94.1%, with preoperative glaucoma and indications other than Fuch’s endothelial dystrophy as risk factors for failure. Five year endothelial cell loss was 67.3%, with cells measured with automatic mode on ConfoScan 4 machine (Nidek). The rate of cell loss in this series was equivalent to 148 cells·mm-2·yr-1 and endothelial cell loss (ECL) over time was modelled on a straight line. This suggests that a fixed amount of cells are lost per unit of time from early postoperative period to five years postoperatively, contrary to the current belief that a rapid substantial cell loss occurs early postoperative and then normalises thereafter. The five-year ECL was higher than previously reported rates from USA and Singapore. The authors hypothesise that organ culture storage media and older donor age might have contributed to increased rates of ECL from the UK data. Despite this, five-year graft survival remained good.