Transfusion-Associated Graft-Versus-Host Disease in Pediatric Patients: Clinical Features and Outcomes.

Background: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, usually fatal complication of blood transfusion.

Objective: To describe the characteristics of TA-GVHD in children.

Methods: The clinical records of pediatric patients diagnosed with TA-GVHD between January 2007 and December 2021 were reviewed.

Results: We analyzed 94 clinical records of pediatric patients (0-18 years) with a diagnosis of GVHD, of whom 6 (6.38%) were associated with TA-GVHD; both genders being equally affected. The median age at diagnosis of the underlying disorder was 9 years, 1 month (range 2 months-15 years, 3 months); the median age at diagnosis of TA-GVHD was 9 years, 5.5 months (range 1 year, 7 months-15 years, 7 months). There were 27 grafts; 8 were irradiated and 12 were filtered. All patients presented with Stage 3 cutaneous TA-GVHD and histopathological Grade 2. All cases corresponded to classic acute TA-GVHD with global clinical Grade I-II. Mortality rate was 67%. The median follow-up of our patients was 2 years and 2 months (range 4 months-3 years, 4 months).

Conclusions: TA-GVHD, although less frequently encountered than in previous years, is still a concern. Early suspicion of TA-GVHD is mandatory due to its high mortality rates and rapid progression. Prevention by using irradiated blood products is the sole effective measure against this condition. Failing to identify and preempt TA-GVHD not only jeopardizes patient survival but also underscores the critical importance of vigilant monitoring and proactive intervention in at-risk patients.