Graft-versus-host disease vs Host-versus-graft rejection
How to tell Graft-versus-host disease and Host-versus-graft rejection apart when a board question makes them look alike.
GVHD is donor immune cells attacking host; host-versus-graft is recipient immune system attacking graft.
Side by side
GVHD occurs when donor T cells attack recipient tissues after transplant, causing rash, diarrhea, liver injury, and immunosuppressed host vulnerability.
Host-versus-graft rejection occurs when recipient immunity attacks transplanted tissue, causing graft dysfunction by hyperacute, acute, or chronic rejection patterns.
GVHD occurs when donor T cells attack recipient tissues after transplant, causing rash, diarrhea, liver injury, and immunosuppressed host vulnerability.
Host-versus-graft rejection occurs when recipient immunity attacks transplanted tissue, causing graft dysfunction by hyperacute, acute, or chronic rejection patterns.
Donor T cells attack host skin, gut, and liver after allogeneic stem cell transplant: rash, diarrhea, cholestasis.
Recipient immunity attacks the graft: hyperacute (minutes, preformed antibodies), acute (days to months, T-cell and/or antibody-mediated), chronic (months to years).
The repair move
Before naming the answer, force the stem through the separator: GVHD is donor immune cells attacking host; host-versus-graft is recipient immune system attacking graft.
Try a free question
CoreA 45-year-old woman receives an allogeneic hematopoietic stem cell transplant from her HLA-matched brother for acute myeloid leukemia. Three weeks later, she develops a diffuse erythematous maculopapular rash starting on the palms and soles, profuse watery diarrhea, and elevated bilirubin. Liver biopsy shows lymphocytic infiltration of bile ducts. Which condition is this?
Show answer and explanation
Answer: A. Acute graft-versus-host disease. Acute graft-versus-host disease occurs when donor T cells attack recipient tissues, classically skin (rash starting palms/soles), GI tract (watery diarrhea), and liver (cholestasis). Risk factors: HLA mismatch, female donor to male recipient, peripheral blood stem cells. Prevent with methotrexate/calcineurin inhibitor; treat with corticosteroids.
Why the other choices are tempting
- B. Acute cellular rejection occurs in solid organ transplantation (kidney, heart, liver) where recipient T cells attack the graft, not donor cells attacking host.
- C. Engraftment syndrome occurs during white cell recovery with non-infectious fever and rash but lacks the GVHD triad of skin, gut, and liver.
- D. Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) presents with hyperbilirubinemia, painful hepatomegaly, and weight gain from conditioning-related sinusoidal endothelial injury.
- E. CMV reactivation can occur but presents with fever, pneumonitis, colitis, or retinitis with viral inclusions, not the classic GVHD triad.
Flashcards
Tap a card to flip it.
What clue supports Graft-versus-host disease?
Choose Graft-versus-host disease when the stem gives this pattern: GVHD occurs when donor T cells attack recipient tissues after transplant, causing rash, diarrhea, liver injury, and immunosuppressed host vulnerability.
What clue supports Host-versus-graft rejection?
Choose Host-versus-graft rejection when the stem gives this contrasting pattern: Host-versus-graft rejection occurs when recipient immunity attacks transplanted tissue, causing graft dysfunction by hyperacute, acute, or chronic rejection patterns.
Quick answers
What is the fastest way to tell Graft-versus-host disease from Host-versus-graft rejection?
GVHD is donor immune cells attacking host; host-versus-graft is recipient immune system attacking graft.
What is the key clue for Graft-versus-host disease?
GVHD occurs when donor T cells attack recipient tissues after transplant, causing rash, diarrhea, liver injury, and immunosuppressed host vulnerability.
What is the key clue for Host-versus-graft rejection?
Host-versus-graft rejection occurs when recipient immunity attacks transplanted tissue, causing graft dysfunction by hyperacute, acute, or chronic rejection patterns.