Transfusion-associated graft-versus-host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second-degree relative, and a survey of predisposing factors.
A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion-associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one-way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA-GVHD.
Petz
L D
LD
Department of Pathology and Laboratory Medicine, University of California Los Angeles.
Calhoun
L
L
Yam
P
P
Cecka
M
M
Schiller
G
G
Faitlowicz
A R
AR
Herron
R
R
Sayah
D
D
Wallace
R B
RB
Belldegrun
A
A
D000368:Aged; D004247:DNA / Q000032:analysis; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000276:immunology*; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006579:Heterozygote; D006650:Histocompatibility Testing; D006720:Homozygote; D006801:Humans; D007121:Immunocompetence; D008297:Male; D012150:Polymorphism, Restriction Fragment Length; D065227:Transfusion Reaction
D006680:HLA Antigens; D004247:DNA