A systematic review of transfusion-associated graft-versus-host disease

Ilana Kopolovic, Jackie Ostro, Hideki Tsubota, Yulia Lin, Christine M. Cserti-Gazdewich, Hans A. Messner, Amy K. Keir, Neal DenHollander, Walter S. Dzik, Jeannie Callum

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57 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)406-414
Number of pages9
Issue number3
Publication statusPublished - 16 Jul 2015

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Kopolovic, I., Ostro, J., Tsubota, H., Lin, Y., Cserti-Gazdewich, C. M., Messner, H. A., ... Callum, J. (2015). A systematic review of transfusion-associated graft-versus-host disease. Blood, 126(3), 406-414. https://doi.org/10.1182/blood-2015-01-620872