Transfusion Support in Solid-Organ Transplantation

Triulzi, Darrell J.

doi:10.1007/978-1-4612-1798-5_7

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“…Thus, organ transplant recipients are at risk of GVHD from three sources: the transplanted organ, cellular blood transfusions, and more recently, concomitant infusion of HPCs from the organ donor (discussed below). There are two major clinical presentations of the graft‐versus‐host reaction in solid organ transplant recipients: 1) a graft‐versus‐host humoral reaction characterized by immune hemolysis from passenger lymphocytes transplanted with the organ 7,8 and 2) a GVHD cellular immune reaction characterized by donor T‐lymphocyte destruction of host tissues. The graft‐versus‐host humoral reaction in solid organ transplantation is well recognized—more than 100 cases have been reported and reviewed extensively elsewhere 7,8 .…”

Section: Gvhdmentioning

confidence: 99%

Microchimerism, GVHD, and tolerance in solid organ transplantation

Triulzi

Nalesnik

2001

Transfusion

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The phenomenon of microchimerism and its relationship to long-term graft tolerance is an area of active study. The ability to establish a tolerant state has been enhanced with current immunosuppressive drugs and emerging therapies such as donor HPC infusions. An undesirable outcome of host-donor WBC interaction is GVHD. GVHD is a rare complication reported most frequently in liver transplantation. Two cases of GVHD reported in recipients of organs from donors homozygous for a shared HLA haplotype would support a policy of avoiding the use of these donors. TA-GVHD is very rare in solid organ transplant recipients, with only four published cases; only two had convincing supportive evidence and one of these had an underlying hematologic abnormality. These few cases do not support a policy of routine irradiation of cellular blood components for all solid organ transplant recipients. The use of donor HPC infusions to enhance chimerism and graft tolerance has increased the number of GVHD cases observed (usually mild) and decreased the severity and number of rejection episodes. The long-term effects of donor HPC infusions on graft survival is under investigation.

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Section: Gvhdmentioning

confidence: 99%