SEARCH RESULTS FOR: Graft-vs-Host-Disease

Graft vs Host Disease

Graft vs Host Disease (GvHD): Pathogenesis and clinical findings Allogeneic hematopoietic stem cell transplant (individual receives donor-derived blood-forming stem cells) Graft contains immunologically competent T lymphocytes Immunocompromised host (e.g., pre-transplant chemotherapy & radiation) is unable to reject incoming donor T lymphocytes Authors: Tanya Cherppukaran Catherine R Jarvis Reviewers: Ryan Rosentreter Luis Murguia Favela* *MD at time of publication Host has tissue antigens (human leukocyte antigens (HLAs) &/or other minor proteins) not present in the donor Donor T lymphocytes recognize host’s tissue as foreign Graft vs Host Disease (GvHD) Donor immune cells attack host’s tissues post transplant Acute GvHD Typically occurs within 100 days post transplant Chronic GvHD Typically occurs >100 days post transplant Damaged tissue activates host antigen-presenting cells Donor T lymphocytes continue to recognize host antigens as foreign & activate B cells Antigen-presenting cells present host antigens to donor T lymphocytes primarily in secondary lymphoid organs (lymph nodes, spleen) B cells produce autoantibodies against host tissues Autoantibodies trigger cytokine release Activated T lymphocytes secrete cytokines → T lymphocytes proliferate Cytokines recruit other immune cells & cause widespread inflammation Cytokines drive chronic inflammation & fibrosis (fibroblasts deposit excess collagen in tissues & replace normal tissue with stiff scar tissue) in target organs Skin Keratinocytes (skin cells) undergo apoptosis (programmed cell death) which damages the epidermis (top skin layer) & triggers a rash Gastrointestinal tract Intestinal epithelial (lining) cells are destroyed Liver Liver bile ducts are damaged Liver Persistent inflammation promotes liver fibrosis Skin Fibrosis scar tissue replaces normal skin dermal tissue Lungs Inflammation & fibrosis narrow bronchioles (small airways) → Bronchiolitis obliterans syndrome Damaged intestinal tract is unable to adequately absorb nutrients & fluid Inflammation & damage causes intestinal ulceration, cramping, & spasms Impaired bile flow (cholestasis) ↑ bilirubin levels in circulation ↑ Alanine & aspartate transaminases (ALT & AST) Bilirubin irritates skin nerve endings Bilirubin deposits in tissues Progressive dyspnea (shortness of breath) Nerve endings in airways become irritated Eyes & Mouth Inflammation damages exocrine glands (tear- & saliva- producing glands) which reduces tear & saliva production Maculopapular rash (red flat patches & small raised bumps) Diarrhea Skin Jaundice sclerosis (yellow discoloration (stiffening Airflow obstruction worsens Abdominal pain Pruritus of skin, sclera & Liver & mucous membranes) failure tightening) +/- vomiting Dry cough (itching) Respiratory failure Legend: Mechanism Sign/Symptom/Lab Finding Complications Published Aug 31, 2026 on www.thecalgaryguide.com Pathophysiology Dry eyes & mouth Creative Commons License