Graft Versus Host Disease Discussion Paper

Graft-versus-host-disease is observed in individuals with allograft transplantation (including a graft from a related or unrelated person). Immune cells play an important role in causing graft versus host disease. The immune cells from the donor tissues attack the host’s tissue. GvHD has two forms that have different symptoms. Skin biopsy is generally done for the diagnosis of GvHD in patients having symptoms of this disease. Advanced technologies are there to prevent the occurrence of GvHD. Immunosuppressive medicines are used as primary therapy is for treatment.

Cause and Mechanism
Graft-versus-host disease has a complex pathophysiology. It is the result of a series of interactions occurring between host tissue and donor’s immune cells. It can also occur by transfusion of blood if it is not irradiated to kill immune cells. GvHD commonly occurs when the recipient has a different human leukocyte antigen (HLA) from the recipient. There are three criteria that are known as Billingham criteria, required to be analyzed for graft-versus-host disease. These three criteria are as follows:

A graft with functional immune cells is administrated.

Donor and recipient are immunologically different, that is, have different HLA antigens.

The recipient is immunocompromised, that is, the immune system is not properly functioning.

After the transplantation of graft tissue in a host, T- lymphocytes (a type of immune cell) of graft tissue recognize host tissues as antigenically foreign and attack those tissues. T-cells produce different cytokines, that is, interferon (IFN)-γ and tumor necrosis factor (TNF)-β. In this process, activation of cytotoxic T lymphocytes occurs, which kills the target tissue cell recognized as foreign.

Types of Graft-versus-Host Disease
Graft-versus-host disease can range from mild to severe life-threatening conditions. GvHD has two different forms namely, acute, and chronic graft-versus-host disease. Both types have different symptoms and affect different organs.

Acute graft-versus-host disease: “Acute” word refers to sudden onset and lasts for a short duration of time. Acute GvHD commonly occurs within hundred days of post-transplantation. Acute graft-versus-host disease usually affects the liver, gastrointestinal tract, and skin. Symptoms of acute GvHD include rashes and burning of the skin (skin symptoms), vomiting, nausea, diarrhea, and abdominal cramps (gastrointestinal symptoms), jaundice (liver symptoms).

Chronic graft-versus-host disease: “Chronic” word refers to a long-lasting condition. Chronic GvHD generally begins three months to 2-year post-transplantation. Its severe cases influence long-term survival and can lead to death. This is a form of graft-versus-host disease that may affect single or several organs. Symptoms of chronic GVHD include the following:

Mouth: dry mouth, ulcer, gum disease, and tooth decay

Skin: rashes, itching of the skin, and change in skin color

Nails: nail texture change, and nail loss

Gastrointestinal tract: vomiting, diarrhea, and abdominal cramps

Shortness of breath

Weight loss, and muscle weakness