Transfusion-associated graft-versus-host disease

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but almost uniformly lethal complication of blood transfusion. In this chapter, the authors review the pathophysiology and incidence of TA-GVHD, characteristics of blood transfusion recipients that make them susceptible to the development of TA-GVHD, and strategies to prevent, diagnose, and treat TA-GVHD. The development of TA-GVHD requires infusion of viable allogeneic donor lymphocytes, which in rare circumstances can proliferate and attack recipient tissues. Prior to the widespread irradiation of cellular blood components in Japan, the reported rate of TA-GVHD in Japan was higher than in Western Europe or the United States. It is important to emphasize that the incidence of TA-GVHD is extremely low and thus cases will only be detected if there is clinical awareness that the diagnosis is a possibility. There are only rare reports of patients surviving TA-GVHD. In one case, recovery was attributed to treatment with anti-CD3 monoclonal antibody and cyclosporine.