Immunology · Transplant, tumors and immunotherapy
Graft-versus-host disease !
- Process
After a donor stem cell transplant, donor immune cells can attack the patient's skin, liver and gut.
Updated 2026-11-01
What it is
Graft-versus-host disease (GVHD) is the reverse of rejection: immunocompetent donor T cells recognize the recipient's tissues as foreign. It occurs mainly after allogeneic hematopoietic stem cell transplant, less often after liver or small bowel transplant or transfusion of non-irradiated blood. Acute GVHD targets the skin, liver and gut; chronic GVHD looks like an autoimmune disease affecting many organs.
Key facts
- Risk is lower with well-matched related donors and higher with unrelated or mismatched donors.
- Prevention uses immunosuppressive drugs after transplant (for example a calcineurin inhibitor with methotrexate) and, in some protocols, post-transplant cyclophosphamide or T-cell depletion.
- Corticosteroids are the first-line treatment for established GVHD.
- Acute and chronic forms are now told apart by their features rather than only by the old 100-day cut-off.
Step by step
- Conditioning chemotherapy or radiation damages host tissues, especially the gut lining.
- Damaged tissue releases inflammatory cytokines (TNF-α, IL-1, IL-6) and microbial products.
- Host antigen-presenting cells activate donor T cells that recognize host HLA or minor antigens.
- Donor T cells expand and release IL-2 and interferon-gamma.
- Cytotoxic T cells and cytokines damage the skin, bile ducts and intestinal epithelium.
Test yourself
Think of the answer, then tap the question to see it.
Which three organs are the main targets of acute graft-versus-host disease?
The skin (rash), liver (cholestatic jaundice) and gastrointestinal tract (diarrhea).
Why does graft-versus-host disease not occur after an autologous transplant?
The cells are the patient's own, so they do not see the host tissues as foreign.
How is transfusion-associated graft-versus-host disease prevented?
By irradiating cellular blood products for at-risk recipients, which stops donor lymphocytes from dividing.
What benefit can donor T cells provide after a transplant for leukemia?
The graft-versus-leukemia effect: they attack remaining leukemia cells.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Transfusion reactions
- MHC/HLA class I and II
- CD8⁺ cytotoxic T cell
- Transplant rejection: hyperacute, acute, chronic
- Immunosuppressants by mechanism (classes)
In Pharmacology
Educational content on the immune system; not a treatment or individual vaccination guide and no substitute for a health professional's advice. No doses are given.
Sources: Graft-versus-host disease (MedlinePlus, U.S. National Library of Medicine, 2026); Transplant rejection (MedlinePlus, U.S. National Library of Medicine, 2026).
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Representative model, for educational purposes only.