A systematic review of transfusion-associated graft-versus-host disease.
Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication of blood transfusion. The clinicolaboratory features of TA-GVHD and the relative contributions of recipient and component factors remain poorly understood. We conducted a systematic review of TA-GVHD reports. The HLA relationship between donor and recipient was classified as D = 0 when no donor antigens were foreign to the recipient vs D ≥ 1 when ≥1 donor antigen disparity occurred. We identified 348 unique cases. Criteria for component irradiation were met in 48.9% of cases (34.5% immune-compromised, 14.4% related-donor), although nonirradiated components were transfused in the vast majority of these (97.6%). Components were typically whole blood and red cells. When reported, component storage duration was ≤10 days in 94%, and 23 (6.6%) were leukoreduced (10 bedside, 2 prestorage, and 11 unknown). Among 84 cases with HLA data available, the category of D = 0 was present in 60 patients (71%) at either HLA class I or II loci and was more common among recipients without traditional indications for component irradiation. These data challenge the historic emphasis on host immune defects in the pathogenesis of TA-GVHD. The dominant mechanism of TA-GVHD in both immunocompetent and compromised hosts is exposure to viable donor lymphocytes not recognized as foreign by, but able to respond against, the recipient.
Department of Medicine, Division of Hematology, and.
Ilana
I
Kopolovic
Department of Medicine, Division of Hematology, and.
Jackie
J
Ostro
Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada;
Hideki
H
Tsubota
Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada;
Yulia
Y
Lin
Department of Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada;
Christine M
http://orcid.org/0000-0002-5297-6406
CM
Cserti-Gazdewich
Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada;
Hans A
HA
Messner
Robinson Institute, University of Adelaide, Adelaide, South Australia;
Amy K
AK
Keir
Regional Histocompatibility Laboratory, University Health Network, Toronto, ON, Canada; and.
Neal
N
DenHollander
Blood Transfusion Service, Massachusetts General Hospital, Boston, MA.
Walter S
WS
Dzik
Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada;
Jeannie
J
Callum
D006086:Graft vs Host Disease / Q000209:etiology*; D006801:Humans; D065227:Transfusion Reaction