Takahashi K
Toranomon Hospital.
Nihon Rinsho. 1997 Sep;55(9):2240-5.
Clinical aspects, pathogenesis and risk factors of transfusion-associated graft versus host disease(TA-GVHD) are summarized. TA-GVHD should be suspected when fever, rashes, diarrhea, liver dysfunction and marrow aplasia occurred 14-30 days after blood transfusion. Almost all the patients suffering from this complication died from severe pancytopenia and grave infection in spite of intensive treatments. Although TA-GVHD have been thought as a rare disease which occurs only in immunosuppressed patients, it is clear now that TA-GVHD may also occur even in immunocompetent patients, in case of so called one-way matching pair of HLA antigens between recipient and donor. When they receive blood without any different HLA antigens from their own, they can neither recognize it non-self nor reject it and at last they may suffer from TA-GVHD. One-way matching of HLA antigens between recipient and donor is important as a risk factor of TA-GVHD especially in immunocompetent patients. Though there is no effective treatment after the onset of this complication, both autologous transfusion and irradiation of blood before transfusion are known to be clearly effective to prevent this complication.
本文总结了输血相关移植物抗宿主病（TA-GVHD）的临床特征、发病机制及危险因素。输血后14-30天若出现发热、皮疹、腹泻、肝功能异常及骨髓抑制等症状，应怀疑TA-GVHD。尽管积极治疗，几乎所有发生该并发症的患者均死于严重全血细胞减少及严重感染。既往认为TA-GVHD是仅发生于免疫抑制患者的罕见疾病，但目前明确即使在免疫功能正常的患者中，若受者与供者HLA抗原呈所谓单向匹配时，也可能发生TA-GVHD。当他们接受的血液HLA抗原与自身无差异时，既无法识别为非己成分，也不能产生排斥反应，最终可能发生TA-GVHD。受者与供者HLA抗原单向匹配作为TA-GVHD的危险因素具有重要意义，尤其在免疫功能正常的患者中。尽管该并发症一旦发生尚无有效治疗方法，但自体输血及输血前血液辐照对预防此并发症均有明确效果。
