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).


TERMINOLOGY


Abbreviations



  • Graft vs. host disease (GVHD)


Definitions



  • 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


ETIOLOGY/PATHOGENESIS


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


CLINICAL ISSUES


Presentation

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