Graft secondary failure

The standard UK definition of leucocyte-depletion is less than 5 x 106 residual leucocytes per unit of red cells or platelets (Pamphilon et al., 1999). Thus, if blood products are used, they should always be irradiated to 2 Gy prior to use, to ensure that the immunosuppressed recipient does not develop transfusion-mediated graft-versus-host disease because of the presence of residual viable lymphocytes in the donated blood product. Such graft-versus-host disease is usually fatal (Aoun et al., 2003 Schroeder, 2002), and causes overwhelming skin desquamation, diarrhoea and liver failure secondary to fibrosis of the biliary system. Even if immunosuppression is given, this is usually insufficient to overcome the problem once allogeneic lymphocytes have engrafted in the recipient. 

Recurrent graft infections may also be secondary to persistent ureteral reflux into the graft, due to a technical failure of ureteral implantation. Retrograde cystography remains the technique of choice to demonstrate this reflux. 

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