Author: Vanessa Ngan, Staff Writer, 2003.
Graft-versus-host disease (GVHD) is a condition where following transplantation the donor's immune cells in the transplant (graft) make antibodies against the patient's tissues (host) and attack vital organs. Organs most often affected include the skin, gastrointestinal (GI) tract and the liver.
Ninety per cent of bone marrow transplants lead to GVHD. Solid organ transplantation, blood transfusions, and maternal-fetal transfusions have also been reported to cause GVHD less frequently.
There are two forms of GVHD.
Acute GVHD and chronic GVHD are distinct diseases. One common factor is that they both increase the patient's susceptibility to infection.
|Acute GVHD||Chronic GVHD|
Graft-versus-graft disease may be suspected in patients who have received a transplant and develop cutaneous or systemic complications. It must be confirmed by a tissue biopsy. See graft-versus-host disease pathology for the cutaneous histological features.
Patients recovering from bone marrow transplantation are usually hospitalised for several weeks following transplant and are monitored closely for signs of developing GVHD or infection. The best treatment for GVHD is prevention. This consists of a cocktail of immunosuppressive drugs such as:
The combination of ciclosporin and methotrexate has been found to significantly decrease the severity of GVHD. These drugs weaken the ability of the donor's immune cells to launch an attack on the patient's organs.
Treatment for patients who do develop GVHD depends on the severity of the disease. Mild cases with only skin involvement of acute GVHD may settle without treatment. More severe acute or chronic GVHD predisposes the patient to infection, and overwhelming sepsis (blood poisoning) is the main cause of death in patients with GVHD. The aim is to treat GVHD before life-threatening sepsis occurs.
Because GVHD affects so many different organs, treatment is usually delivered by a multi-disciplinary team of transplant doctors, dermatologists, respiratory doctors, gastroenterologists, ophthalmologists, and other specialists.
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