Central Blood Institute, Japanese Red Cross Society, 2-1-67, Tatsumi, Koto-ku, Tokyo 135-8521, Japan.
Biodosimetry Group, National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan.
Transfus Apher Sci. 2022 Apr;61(2):103403. doi: 10.1016/j.transci.2022.103403. Epub 2022 Mar 10.
Pathological mechanisms proposed for transfusion-associated graft-versus-host diseases (TA-GVHD) include HLA homozygosity in donor cells of the transfusion unit that is shared by the recipient (one-way HLA match) and immunosuppression in the transfusion recipient. Which of these factors is indispensable or to what degree each factor contributes to the development of TA-GVHD has been the issue of debate. In countries like Japan with higher HLA homogeneity, TA-GVHD occurrence was thought to be primarily dependent on the one-way HLA match mechanism regardless of immunosuppression. Accordingly, universal irradiation of blood components has been conducted with no further TA-GVHD cases. In other developed countries, in contrast, TA-GVHD was thought to be a sort of extrapolation of GVHD observed among heavily immunosuppressed patients. Guidelines with the detailed list of diseases with the indication for irradiated components have been established in those countries. Although TA-GVHD occurrence decreased markedly after the introduction of universal leukoreduction, a considerable number of TA-GVHD cases have occurred among immunocompetent patients mostly by the one-way HLA match mechanism. Because one-way HLA matching with donor homozygosity is thought to be a ubiquitous and independent mechanism for TA-GVHD, it could occur in any transfusion setting regardless of immunosuppression. It would be thoughtful to select an area-specific strategy considering the drawbacks of irradiation and the frequency of TA-GVHD in that area. However, if complete abolition of TA-GVHD is required from the perspective of the high fatality of the disorder, universal irradiation of cellular components will be necessary.
输血相关性移植物抗宿主病（TA-GVHD）的发病机制包括供者细胞中的 HLA 纯合性与受者共享（单向 HLA 匹配）和输血受者的免疫抑制。这些因素中，哪个是不可或缺的，或者每个因素对 TA-GVHD 的发展贡献程度如何，一直是争论的问题。在日本等 HLA 同质性较高的国家，TA-GVHD 的发生被认为主要取决于单向 HLA 匹配机制，而与免疫抑制无关。因此，已经对血液成分进行了普遍照射，没有再发生 TA-GVHD 病例。相比之下，在其他发达国家，TA-GVHD 被认为是一种在严重免疫抑制患者中观察到的 GVHD 的外推。这些国家制定了带有照射成分适应证详细列表的指南。尽管在引入普遍白细胞减少后 TA-GVHD 的发生明显减少，但在免疫功能正常的患者中，由于单向 HLA 匹配机制，仍发生了相当数量的 TA-GVHD 病例。由于单向 HLA 匹配与供者纯合性被认为是 TA-GVHD 的普遍和独立机制，因此无论免疫抑制如何，它都可能在任何输血情况下发生。考虑到照射的缺点和该地区 TA-GVHD 的频率，选择一个特定地区的策略是明智的。然而，如果从该疾病高死亡率的角度来看需要完全消除 TA-GVHD，则需要对细胞成分进行普遍照射。
