PMID- 14703935
OWN - NLM
STAT- MEDLINE
DCOM- 20040129
LR  - 20191108
IS  - 0902-0063 (Print)
IS  - 0902-0063 (Linking)
VI  - 17
IP  - 5
DP  - 2003 Oct
TI  - Transfusion-associated graft vs. host disease after donor-specific leukocyte 
      transfusion before kidney transplantation.
PG  - 477-83
AB  - Transfusion-associated graft vs. host disease (TA-GVHD) is a well-known but rare 
      complication that follows infusion of histo-incompatible lymphoid cells, often 
      seen in individuals with impaired cellular immunity. However, we present here a 
      case report of fatal TA-GVHD in a 'presumed' immunocompetent patient after 
      transfusion of a freshly isolated buffycoat from a relative as part of our 
      protocol to prepare the patient for living-related kidney transplantation. To 
      confirm the diagnosis of TA-GVHD, a polymerase chain reaction was used to detect 
      donor cells in various affected tissues. Furthermore, the immune reactivity of 
      the patient against donor and vice versa was tested on samples taken before 
      transfusion using limiting dilution assays. Our patient received a transfusion 
      with blood from a donor who was homozygous at the human leukocyte antigen (HLA) 
      class I loci. Despite incompatibility for HLA class II, infused donor T 
      lymphocytes were not rejected and became engrafted. The patient did not have 
      cytotoxic T lymphocytes to reject the donor cells. DNA polymorphism studies on 
      several organ biopsies confirmed the presence of infiltrating cells of donor 
      origin. This report illustrates the possibility, in the general patient 
      population, of developing TA-GVHD from whole blood transfusion. In the case of 
      pre-transplant blood transfusion, the patient and donor have to be HLA-typed and 
      special care should be taken in the situation of donor homozygosity for HLA class 
      I, even in the presence of HLA class II incompatibility. Protocols in which 
      donor-specific blood or bone marrow transfusions are given in an attempt to 
      modulate the immune system should exclude these combinations.
FAU - van der Mast, Barbara J
AU  - van der Mast BJ
AD  - Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The 
      Netherlands. b.vandermast@erasmusmc.nl
FAU - van den Dorpel, Marinus A
AU  - van den Dorpel MA
FAU - Drabbels, Jos J M
AU  - Drabbels JJ
FAU - Claas, Frans H J
AU  - Claas FH
FAU - Weimar, Willem
AU  - Weimar W
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
SB  - IM
MH  - Adult
MH  - Blood Group Incompatibility/complications
MH  - Fatal Outcome
MH  - Female
MH  - Graft vs Host Disease/diagnosis/*etiology/immunology
MH  - Humans
MH  - *Kidney Transplantation
MH  - Leukocyte Transfusion/*adverse effects
MH  - Living Donors
MH  - T-Lymphocytes, Cytotoxic
MH  - Transplantation Chimera
MH  - Transplantation Conditioning/*adverse effects
EDAT- 2004/01/06 05:00
MHDA- 2004/01/30 05:00
CRDT- 2004/01/06 05:00
PHST- 2004/01/06 05:00 [pubmed]
PHST- 2004/01/30 05:00 [medline]
PHST- 2004/01/06 05:00 [entrez]
AID - 10.1034/j.1399-0012.2003.00074.x [doi]
PST - ppublish
SO  - Clin Transplant. 2003 Oct;17(5):477-83. doi: 10.1034/j.1399-0012.2003.00074.x.