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. Although the graft-versus-host disease (GVHD) that occurs after allogeneic bone marrow transplantation and TA-GVHD share some clinical similarities, GVHD after bone marrow transplant is not uncommon and often responds positively to immunosuppression. The much rarer TA-GVHD, however, in contradistinction to bone marrowGVHD, is associated with destruction of the recipient’s bone marrow, does not respond to immunosuppressive therapy, and is generally fatal. Because there are no effective treatments for TAGVHD,management of this complication focuses almost entirely on prevention by irradiation of cellular blood components (whole blood, red blood cells [RBCs], granulocytes, and platelets) that are intended for susceptible recipients. Over the past 10–15 years, the use of irradiation in high-risk situations has reduced the incidence of TA-GVHD in the Western world and Japan to almost undetectable levels. In this chapter, we review thepathophysiology 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.