[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Immunology](https://durgical.com/en/immunology/) › [Transplant, tumors and immunotherapy](https://durgical.com/en/immunology/#a-transplant) › Graft-versus-host disease

[Immunology](https://durgical.com/en/immunology/) · [Transplant, tumors and immunotherapy](https://durgical.com/en/immunology/#a-transplant)

# 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

**See it in 3D:** [Skin](https://durgical.com/en/anatomy/skin/) · [Liver](https://durgical.com/en/anatomy/liver/)

## Key points

- Three requirements: the graft contains immunocompetent T cells, the host cannot reject them, and donor and host differ in HLA or minor antigens.
- Acute GVHD: maculopapular rash (often palms and soles), cholestatic liver injury with jaundice, and watery or bloody diarrhea.
- Chronic GVHD: scleroderma-like skin, dry eyes and mouth, lichen planus-like mouth lesions, bronchiolitis obliterans, joint stiffness.
- Does not occur after autologous transplant (own cells).
- Transfusion-associated GVHD is rare but usually fatal; it is prevented by irradiating blood products for at-risk patients.
- The same donor T cells also attack residual leukemia: the graft-versus-leukemia effect.

## 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.

## Memory aid

In rejection the host attacks the guest; in GVHD the guest attacks the host, first at skin, liver and gut.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/immunology/graft-versus-host-disease/)

## See it in 3D

The structures of Durgical's 3D anatomy where it is found.

- [Skin](https://durgical.com/en/anatomy/skin/)
- [Liver](https://durgical.com/en/anatomy/liver/)

## Related

- [Transfusion reactions](https://durgical.com/en/immunology/transfusion-reactions/)
- [MHC/HLA class I and II](https://durgical.com/en/immunology/mhc-hla-class-i-and-ii/)
- [CD8⁺ cytotoxic T cell](https://durgical.com/en/immunology/cd8-cytotoxic-t-cell/)
- [Transplant rejection: hyperacute, acute, chronic](https://durgical.com/en/immunology/transplant-rejection-hyperacute-acute-chronic/)
- [Immunosuppressants by mechanism (classes)](https://durgical.com/en/immunology/immunosuppressants-by-mechanism/)

## In Pharmacology

- [Methotrexate](https://durgical.com/en/pharmacology/methotrexate/)
- [Tacrolimus](https://durgical.com/en/pharmacology/tacrolimus/)

[← All of immunology](https://durgical.com/en/immunology/)

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](https://medlineplus.gov/ency/article/001309.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Transplant rejection](https://medlineplus.gov/ency/article/000815.htm) (MedlinePlus, U.S. National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/immunology/graft-versus-host-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/immunology/graft-versus-host-disease/