Transfusion-associated graft-versus-host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second-degree relative, and a survey of predisposing factors

• Published in: Transfusion (Philadelphia, Pa.) Vol. 33; no. 9; p. 742
• Main Authors: Petz, L D, Calhoun, L, Yam, P, Cecka, M, Schiller, G, Faitlowicz, A R, Herron, R, Sayah, D, Wallace, R B, Belldegrun, A
• Format: Journal Article
• Language: English
• Published: United States 01.09.1993
• Subjects: Aged; DNA - analysis; Fatal Outcome; Graft vs Host Disease - immunology; Heterozygote; Histocompatibility Testing; HLA Antigens - genetics; HLA Antigens - immunology; Homozygote; Humans; Immunocompetence; Male; Polymorphism, Restriction Fragment Length; Transfusion Reaction
• DOI: 10.1046/j.1537-2995.1993.33994025025.x
• ISSN: 0041-1132

A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion-associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one-way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA-GVHD.