USMLE

Graft vs Host Disease (GVHD)

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Transplant Rejection
  1. Hyperacute Transplant Rejection
  2. Acute Transplant Rejection
  3. Chronic Transplant Rejection
  4. Graft vs Host Disease (GVHD)

Summary

Graft vs. Host Disease (GVHD) is a pathology that can occur after organ transplant. GVHD occurs when donor or grafted T-cells attack the cells of an immunocompromised host, causing widespread or systemic damage. GVHD is commonly seen after bone marrow and liver transplants, since these transplanted organs contain a high number of T-lymphocytes. 

Key Points

  • Graft vs. Host Disease (GVHD
    • Variable onset after transplantation / transfusion
    • Donor T cells in graft / transfusion attack an immunocompromised recipient
      • Host immune system unable to kill foreign T-cells, since immunosuppression is necessary for transplant rejection prophylaxis
      • Example of Type IV Hypersensitivity Reaction
    • Usually seen in bone marrow and liver transplants
      • These organs are rich in T-lymphocytes
    • Widespread / systemic symptoms (since donor T cells migrate into host)
      • Maculopapular rash (skin)
      • Diarrhea and abdominal pain (GI tract)
      • Jaundice and hepatosplenomegaly (liver)
    • May be beneficial in cancer patients, due to graft vs. tumor effect
      • Donor T cells may attack host tumor cells
    • Can be prevented by irradiation of blood products / organs prior to transfusion / transplant
      • Kills T-lymphocytes, but can also damage other cells