title: Survival of donor leukocyte subpopulations in immunocompetent transfusion recipients: frequent long-term microchimerism in severe trauma patients.
abstract: We recently reported detection of a transient increase in circulating donor leukocytes (WBCs) in immunocompetent recipients 3 to 5 days posttransfusion (tx) (Blood 85:1207, 1995). We have now characterized survival kinetics of specific donor WBC subsets in additional tx populations. Eight female elective surgery patients (pts) were sampled pre-tx and on days 1, 3, 5, 7, and 14 post-tx. Ten female trauma pts transfused with a total of 4 to 18 U of relatively fresh red blood cells were sampled up to 1.5 years post-tx. WBC subsets from frozen whole blood were isolated using CD4, CD8 (T cell), CD15 (myeloid), and CD19 (B cell) antibody-coated magnetic beads. Donor WBCs were counted by quantitative polymerase chain reaction (PCR) of male-specific sex determining region (SRY) sequences. PCR HLA typing and mixed leukocyte reaction (MLR) between recipient and donor WBCs were performed on two of the trauma tx recipients who had long-term chimerism of donor cells post-tx. In 6 of 8 female surgery pts, circulating CD4(+) male donor cells peaked at day 3 or 5 (0.01 to 1 cell/microL), followed by clearance by day 14. In 7 of 10 female trauma pts, we observed multilineage persistence of male donor WBCs (CD4, CD8, CD15, CD19) for 6 months to 1.5 years post-tx at concentrations of 10 to 100 cells/microL. In 2 trauma recipients studied, MLR showed no, or very low, response to WBC of the single donor implicated as the source of microchimerism by HLA typing. Establishment of long-term multilineage chimerism in trauma recipients is probably caused by engraftment of donor stem cells and mutual tolerance between recipient and donor leukocytes. A better understanding of factors determining clearance versus chimerism of transfused leukocytes is critical to prevention of alloimmunization and transfusion-induced graft-versus-host disease, and, potentially, to induction of tolerance for transplantation.
authors.affiliation: Research and Scientific Services, Blood Centers of the Pacific (formerly Irwin Memorial Blood Centers), San Francisco, CA, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Lee
authors.forename: T
authors.initials: T
authors.lastname: Paglieroni
authors.forename: H
authors.initials: H
authors.lastname: Ohto
authors.forename: P V
authors.initials: PV
authors.lastname: Holland
authors.forename: M P
authors.initials: MP
authors.lastname: Busch
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000097:blood; D001483:Base Sequence; D001782:Blood Donors; D002470:Cell Survival; D017931:DNA Primers; D004268:DNA-Binding Proteins / Q000235:genetics*; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006684:HLA-DR Antigens / Q000097:blood; D006650:Histocompatibility Testing; D006801:Humans; D007962:Leukocytes / Q000166:cytology* / Q000276:immunology*; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D008875:Middle Aged; D009687:Nuclear Proteins; D015345:Oligonucleotide Probes; D051876:Sex-Determining Region Y Protein; D014157:Transcription Factors; D018183:Transplantation Chimera; D014947:Wounds and Injuries / Q000601:surgery / Q000628:therapy*
chemical_list: D015703:Antigens, CD; D017931:DNA Primers; D004268:DNA-Binding Proteins; D006684:HLA-DR Antigens; D009687:Nuclear Proteins; D015345:Oligonucleotide Probes; C497745:SRY protein, human; D051876:Sex-Determining Region Y Protein; D014157:Transcription Factors