Analysis of 66 patients definitive with transfusion‐associated graft‐versus‐host disease and the effect of universal irradiation of blood

Uchida, Shigeharu; Tadokoro, Kenji; Takahashi, Masahiko; Yahagi, H.; Satake, Masahiro; Juji, Takeo

doi:10.1111/tme.12081

Cited by 48 publications

(42 citation statements)

References 22 publications

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“…Even though it is a rare complication of allogeneic blood transfusion, in countries such as Japan where there is high ethic homogeneity of the blood supply, the increased risk of GvHD has led to the routine irradiation of all blood components. 16 Where irradiated blood components are not commonly used, the effect of subtle molecular changes after transfusion could be under reported especially when complications such as multi-organ failure are readily attributable to the original trauma. Furthermore, it has been speculated that alloimmunization from microchimerism could adversely affect both the eligibility for transplantation and the ability to procure compatible blood for transfusion.…”

Section: Introductionmentioning

confidence: 99%

Leukodepleted blood components do not remove the potential for long-term transfusion-associated microchimerism in Australian major trauma patients

et al. 2014

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Section: Introductionmentioning

confidence: 99%

Leukodepleted blood components do not remove the potential for long-term transfusion-associated microchimerism in Australian major trauma patients

et al. 2014

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“…Interestingly, in several cases designated as D $ 1 in our series, the donor nevertheless harbored only few and subtle differences in HLA antigens compared with those present in the recipient, therein underestimating the true extent of potential host tolerance. 3,[38][39][40][41][42][43][44] Although D 5 0 represents the ultimate surveillance escape, it is possible that nonrecognition is achievable by other variations.…”

Section: Org Frommentioning

confidence: 99%

“…Mortality in TA-GVHD has been estimated to be between 90% and 100%. [2][3][4][5] According to criteria devised by the National Health and Safety Network (NHSN), the diagnosis of TA-GVHD is based on a combination of characteristic clinical findings and a tissue biopsy consistent with GVHD, with imputability established via the demonstration of leukocyte chimerism, specifically donor lymphocytes in recipient tissue (Table 1). 6 The predominant factors leading to TA-GVHD have yet to be fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

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

Kopolovic¹,

Ostro²,

Tsubota

et al. 2015

Blood

160

163

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• Fifty percent of TA-GVHD cases occur in patients who would not be predicted to be at risk for TA-GVHD by current guidelines for blood irradiation.• Donor lymphocytes whose HLA antigens are all shared by the recipient dominate in TA-GVHD cases, particularly in immune-competent recipients.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 5 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 5 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. (Blood. 2015;126(3):406-414)

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“…Quality guidelines for leukocyte-reduced apheresis PLT concentrates (APCs) define a maximal leukocyte count of <5 × 10 6 /l [4]. Since this limited number of remaining leukocytes may cause TA-GVHD, even leukocyte-reduced PLT concentrates have to be gamma-irradiated [5,6]. For PLTs and plasma, but not for red blood cell concentrates (RBCs), photochemical pathogen reduction technologies like riboflavin plus ultraviolet light irradiation may be an alternative [7,8].…”

Section: Introductionmentioning

confidence: 99%

Transfusion Efficacy of Apheresis Platelet Concentrates Irradiated at the Day of Transfusion Is Significantly Superior Compared to Platelets Irradiated in Advance

Julmy

Ammann

Fontana

et al. 2014

Transfus Med Hemother

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Background: Gamma irradiation is currently the standard care to avoid transfusion-associated graft-versus-host disease. Guidelines on gamma irradiation of blood components state that platelets (PLTs) can be irradiated at any stage in their 5-day storage and can thereafter be stored up to their normal shelf life of 5 days after collection. In this study, we explored whether the timing of irradiation has an effect on transfusion efficacy of apheresis PLT concentrates (APCs). Methods: Based on the 1-hour percent PLT recovery (PPR_1h), transfusion efficacy of 1,000 eligible APCs transfused to 144 children were evaluated retrospectively. PPR_1h was compared in transfused APCs irradiated at the day of transfusion and APCs irradiated in advance. Results: In univariate analysis, transfusion efficacy of APCs irradiated in advance was significantly lower than that of APCs irradiated at the day of transfusion (mean PPR_1h 27.7 vs. 35.0%; p = 0.007). This was confirmed in multivariate analysis (p = 0.030). Compared to non-irradiated APCs, transfusion efficacy of APCs irradiated at the day of transfusion was not significantly inferior (mean difference -2.8%; 95% CI -6.1 to 0.5%; p = 0.092), but APCs irradiated in advance were clearly less efficient (mean difference -8.1%; 95% CI -12.2 to -4.0%; p < 0.001). Conclusion: Our data strongly support that APCs should not be irradiated in advance, i.e., ≥24 h before transfusion.

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Analysis of 66 patients definitive with transfusion‐associated graft‐versus‐host disease and the effect of universal irradiation of blood

Abstract: No cases of TA-GVHD development have been confirmed since 2000, when the supply of irradiated blood products became widespread. No major problems have been encountered since the start of universal irradiation, more than 10 years ago.

Cited by 48 publications

References 22 publications

Leukodepleted blood components do not remove the potential for long-term transfusion-associated microchimerism in Australian major trauma patients

Leukodepleted blood components do not remove the potential for long-term transfusion-associated microchimerism in Australian major trauma patients

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

Transfusion Efficacy of Apheresis Platelet Concentrates Irradiated at the Day of Transfusion Is Significantly Superior Compared to Platelets Irradiated in Advance

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