Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) occurs when immunocompetent donor T lymphocytes carried in a graft recognize the recipient's tissue antigens as foreign. The activated donor cells release inflammatory cytokines and recruit further immune activity, damaging host tissues. The skin, liver and gastrointestinal tract are the classic acute targets; chronic GVHD can involve almost any organ, including the eyes, mouth, lungs, joints, fascia and genital tract. GVHD is mainly a complication of allogeneic hematopoietic stem cell transplant (HSCT), in which the graft comes from another person. It is the reverse of graft rejection: in rejection the recipient's immune system attacks the graft, while in GVHD immune cells from the graft attack the recipient. A related but separate condition, transfusion-associated GVHD, can follow transfusion of cellular blood components that contain viable donor lymphocytes (see the transfusion section). Epidemiology that matters for nursing: a 2020 review of steroid-refractory acute GVHD (Malard and colleagues, Leukemia) reports that acute GVHD occurs in about 30% to 50% of allogeneic HSCT recipients, that 14% to 36% develop severe disease, and that about 35% to 50% of patients become refractory...