Transfusion-Associated Graft Versus Host Disease in the Immunocompetent Patient

Abstract

Transfusion associated-graft versus host disease (TA-GVHD) is a rare complication of blood transfusion. It carries a very high mortality rate. Although the phenomenon has been well described in immunocompromised patients, this review focuses on the immunocompetent host. Cases of TA-GVHD continue to be reported following a variety of surgical procedures, especially cardiac procedures requiring cardiopulmonary bypass. Additional risk factors for TA-GVHD include blood component transfusion in populations with limited genetic diversity, the use of directed donations from family members, and the transfusion of fresh blood. As there is no effective treatment, the focus is on prevention.

Amotosalen/UVA treatment inactivates T cells more effectively than the recommended gamma dose for prevention of transfusion‐associated graft‐versus‐host disease

“…Prevention of TA‐GVHD is accomplished by using gamma‐irradiated blood components for patients at risk; however, identifying such patients is challenging. TA‐GVHD was first recognized in patients with varying degrees of immunosuppression, although early instances from Japan and later instances of family donors around the world highlighted that immunocompetent patients may still be susceptible to the disease when their genetic similarity with the donor T cells makes their immune system unable to defend against donor cell attack . In addition, immune suppression may be difficult to predict, as it is affected by factors such as genetic makeup, age, etc., and can be temporarily induced by disease and trauma.…”

“…TA-GVHD was first recognized in patients with varying degrees of immunosuppression, although early instances from Japan 5 and later instances of family donors around the world 6,7 highlighted that immunocompetent patients may still be susceptible to the disease when their genetic similarity with the donor T cells makes their immune system unable to defend against donor cell attack. 8 In addition, immune suppression may be difficult to predict, as it is affected by factors such as genetic makeup, age, etc., and can be temporarily induced by disease and trauma. A recent review of the literature showed that approximately 60% of TA-GVHD cases followed transfusion of nonirradiated blood components to recipients not identified as being at risk, indicating that treatment of all components may be a better strategy.…”

Anti-CD3 Antibody Ameliorates Transfusion-Associated Graft-Versus-Host Disease in a Chemotherapy-Based Mouse Model With Busulfan and Fludarabine

“…The risk factors of this disease include the number and immunoreactivity of contaminating lymphocytes in transfusion components. The dominant mechanism of TA-GVHD in immunocompetent and compromised hosts is exposure to viable donor lymphocytes that are responsive against recipients but are not recognized as foreign substances (3,15) . Similar to GVHD, TA-GVHD requires an immunoactive component, difference in MHC between a donor and a recipient, and susceptibility of a patient's immune system to the engraftment of donor lymphocytes.…”

“…Immunosuppressive patients who receive blood transfusion containing immuneactive lymphocytes are prone to serious clinical syndromes (2) . With extensive applications of immunosuppressive nucleotide analogs, such as fludarabine, the incidence of TA-GVHD increases annually (3) . TA-GVHD usually occurs in immunosuppressive and immunodeficient patients.…”

“…TA-GVHD progresses rapidly and presents poor prognosis. With the increasing application of immunosuppression therapy, the incidence of TA-GVHD has also significantly increased (3) . This disease is commonly treated with large doses of dexamethasone (Dex), antithymocyte globulin (ATG), and immune inhibitors, such as cyclosporine A (CsA) and cyclophosphamide (CTX).…”