Complications of Surgical and Medical Care Codexery

Graft-versus-host disease

Donor immune cells attack recipient tissues after transplant.

Graft-versus-host disease (GVHD) is a potentially life-threatening complication that can occur after certain stem cell or bone marrow transplants.[1] It happens when donor cells from the transplant attack one or more of the recipient's organs.[2] The disease is caused by immune cells from the donor attacking those of the recipient.[3]

Key facts and history

Three criteria, known as the Billingham criteria, must be met for GVHD to occur: an immuno-competent graft is administered, the recipient is immunologically different from the donor, and the recipient is immunocompromised.[4] About one-third to one-half of allogeneic transplant recipients will develop acute GVHD.[5] Following a bone marrow transplant, donor T cells, whether accidentally included or deliberately added, target the recipient's tissues because they are seen as antigenically different.[6] The acute variant, aGVHD, typically appears between 10 and 100 days after the transplant procedure and presents a significant problem due to the illness and death it can cause.[5]

If blood products that have not been gamma irradiated or treated with an approved leukocyte reduction system are used, GVHD can develop after a transfusion; this is termed transfusion-associated graft-versus-host disease (TA-GvHD).[7] TA-GvHD carries a high death rate of 80–90%, linked to the involvement of bone marrow lymphoid tissue.[8]

What the research sources say

Up to 47% of allo transplant recipients will develop acute GVHD, and it is less common in younger people and those with closer HLA matches.[2] The same source states that chronic GVHD can start anywhere from about 100 to 600 days after a stem cell transplant, and up to half of allo transplant recipients will develop it.[2] MedlinePlus reports that common acute symptoms include abdominal pain, nausea, vomiting, diarrhea, jaundice, skin rash, and increased risk for infections.[1]

References

  1. "Graft-versus-host disease", MedlinePlus. facts only, no text reused. medlineplus.gov
  2. "Stem Cell or Bone Marrow Transplant Side Effects", www.cancer.org. facts only, no text reused. cancer.org
  3. "Immune war with donor cells after transplant may wipe out HIV", ?, 3 May 2017. facts only, no text reused. newscientist.com
  4. Wikipedia, "Graft-versus-host disease" (CC BY-SA 4.0), which cites: "The biology of graft-versus-host reactions", Harvey Lectures, 1966, p. 21–78 (original not read by us) en.wikipedia.org
  5. Wikipedia, "Graft-versus-host disease" (CC BY-SA 4.0), which cites: "Acute and chronic Graft-versus-host disease after hematopoietic stem cell transplantation", Revista da Associação Médica Brasileira, October 2016, p. 44–50; "Stem Cell or Bone Marrow Transplant Side Effects", www.cancer.org; "Acute graft-vs-host disease: pathobiology and management", Experimental Hematology, March 2001, p. 259–77; "Stem Cell or Bone Marrow Transplant Side Effects", www.cancer.org; "Stem Cell or Bone Marrow Transplant Side Effects", www.cancer.org (we also read that source) en.wikipedia.org
  6. Wikipedia, "Graft-versus-host disease" (CC BY-SA 4.0), which cites: "Effect of HLA mismatch on acute graft-versus-host disease", International Journal of Hematology, September 2013, p. 300–8; "Acute GVHD prophylaxis plus ATLG after myeloablative allogeneic haemopoietic peripheral blood stem-cell transplantation from HLA-identical siblings in patients with acute myeloid leukaemia in remission: final results of; "Immunological considerations for embryonic and induced pluripotent stem cell banking", Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, August 2 en.wikipedia.org
  7. Wikipedia, "Graft-versus-host disease" (CC BY-SA 4.0), which cites: Williamson, "Transfusion associated graft versus host disease and its prevention", Heart, 1 September 1998, p. 211–212 (original not read by us) en.wikipedia.org
  8. Wikipedia, "Graft-versus-host disease" (CC BY-SA 4.0), which cites: "Principles of blood irradiation, dose validation, and quality control", Transfusion, October 1997, p. 1084–92 (original not read by us) en.wikipedia.org

Each numbered sentence above was checked against the source it cites before publication. Sentences citing Wikipedia adapt text from the English Wikipedia article Graft-versus-host disease (contributors), used under CC BY-SA 4.0; this entry is available under the same licence. Other sources were used for facts only; no text or images are copied from them.

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