Transfusion-associated graft-versus-host disease with transfusion practice in cardiac surgery.
BACKGROUND
Transfusion-associated graft-versus-host disease (TA-GVHD) in immunocompetent patients has still been underdiagnosed and underreported. Risk of TA-GVHD caused by transfusion practice in cardiac surgery should be appropriately recognized.


METHODS
The correlation of TA-GVHD with transfusion practice in cardiac surgery was analyzed from our 17-year clinical experience. We retrospectively reviewed 2,686 consecutive adult patients who underwent cardiac surgery between 1980 and 1996. Classified according to transfusion practice, 847 patients (32%) received nonirradiated fresh homologous whole blood (mean per patient, 5+/-2 units) with or without other blood components; 592 patients (22%) nonirradiated stored RBCs older than 7 days (4+/-2), and 551 patients (21%) received irradiated homologous blood including, fresh whole blood (2+/-1), RBCs (4+/-1), and PCs (8+/-3), respectively. The remaining 696 patients (25%), did not require homologous transfusion.


RESULTS
Four of 847 patients who received nonirradiated fresh homologous whole blood (< or =48 hours after donation) developed TA-GVHD. TA-GVHD did not occur in other patients.


CONCLUSIONS
Our local experience demonstrates the incidence of TA-GVHD in patients who received fresh homologous whole blood in cardiac surgery was much higher, compared with previous reports. This result suggests that the frequency of TA-GVHD is nearly similar to the value calculated from the proportion of HLA haplotypes in the population.
Yasuura
K
K
Department of Thoracic Surgery, Nagoya University School of Medicine, Japan.
Okamoto
H
H
Matsuura
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000150:complications* / Q000235:genetics / Q000276:immunology / Q000473:pathology; D006348:Cardiac Surgical Procedures; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006239:Haplotypes; D006331:Heart Diseases / Q000601:surgery; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D065227:Transfusion Reaction
D006680:HLA Antigens