Graft vs. Host Disease

Graft vs. Host Disease

Julie E. Jackson, MD

Chandra N. Smart, MD

Clinical photo of acute GVHD shows ill-defined violaceous papules & macules image with overlying scale image. This was in a generalized morbilliform distribution. (Courtesy S. Worswick, MD.)

Grade I acute GVHD shows sparse interface changes image with few apoptotic keratinocytes image and closely associated lymphocytes (satellite cell necrosis).



  • Graft vs. host disease (GVHD)


  • Multisystem disease affecting skin and gastrointestinal tract, occurring in immunosuppressed transplant recipients

  • Occurs as a result of immunocompetent donor T lymphocytes responding to incompatible foreign host major histocompatibility complex (MHC) antigens

  • Acute GVHD

    • Classically occurs within 100 days of transplant with peak incidence around day 30

  • Chronic GVHD

    • Typically occurs within 3-5 months after grafting and primarily consists of either lichen planus-like eruption or sclerodermoid form


Proposed Immunologic Mechanisms

  • Donor T-lymphocytes activate and proliferate in setting of immunocompromised host because the host cannot reject the transplanted cells

  • Pretransplant tissue damage, through radiation or chemotherapy, is thought to increase recognition of host’s antigens by donor’s T-lymphocytes

  • Donor T-lymphocytes cause host cell death through cytotoxic T-cell effects mediated by perforin, granzyme, and apoptosis through Fas/Fas ligand pathway

  • Occurrence related to HLA mismatch but minority of cases develop due to mismatch of minor histocompatibility antigens



  • Most commonly occurs in allogenic bone marrow transplants, but also reported in

    • Solid organ transplantation, severely immunosuppressed patients following transfusion of non-irradiated blood products, transplacentally to immunodeficient fetus, and rarely in autologous transplants

  • Acute GVHD

    • Initially, a morbilliform rash characterized by erythematous macules & papules with possible mucosal involvement

    • Begins with punctate lesions around adnexal structures involving face, trunk, palms, & soles

    • Can also present as acral erythema, an eczema-like eruption, ichthyosis, or, in severe cases, erythroderma with diffuse desquamation mimicking toxic epidermal necrolysis

    • Other clinical features include cholestatic hepatitis with increased bilirubin and high-volume diarrhea

  • Chronic GVHD

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Graft vs. Host Disease

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