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