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TA-GVHD occurs when viable donor T-lymphocytes in transfused blood components engraft in the recipient and mount an immune response against tissue antigens. Normally, immunocompetent recipients quickly eliminate donor T-cells, which prevents TA-GVHD. However, a patient with a weakened immune system may not be able to clear donor T-cells, especially if those viable donor T-cells are sufficiently similar in human leukocyte antigen (HLA) expression to that of the recipient’s T-cells. In this case, the recipient’s immune system will not recognise the donor T-cells as foreign. Rather than being cleared, these donor T-cells may proliferate and attack recipient tissues and organs, resulting in TA-GVHD.
The primary risk factors in TA-GVHD include:
- Number of viable T-lymphocytes transfused
- Degree of recipient immunodeficiency
- Similarity in human leukocyte antigen (HLA) expression between the donor and recipient