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|Title:||A systematic review of transfusion-associated graft-versus-host disease|
|Citation:||Blood, 2015; 126(3):406-414|
|Publisher:||American Society of Hematology|
|Ilana Kopolovic, Jackie Ostro, Hideki Tsubota, Yulia Lin, Christine M. Cserti-Gazdewich, Hans A. Messner, Amy K. Keir, Neal DenHollander, Walter S. Dzik, and Jeannie Callum|
|Abstract:||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 Human Leukocyte Antigen (HLA) relationship between donor and recipient was classified as D=0 when no donor antigens were foreign to the recipient, versus D≥1 when ≥1 donor antigen disparity occurred. We identified 348 unique cases. Criteria for component irradiation were met in 48.9% cases(34.5% immune-compromised, 14.4% related-donor), though non-irradiated 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 pre-storage, 11 unknown). Among 84 cases with HLA data available, the category of D=0 was present in 60(71%) patients 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.|
Graft vs Host Disease
|Description:||Accepted April 14, 2015.|
|Rights:||© 2015 American Society of Hematology|
|Appears in Collections:||Aurora harvest 2|
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