Review Question - QID 100463

The patient in the question is suffering from graft-versus-host disease (GVHD) following liver transplantation. In GVHD there is donor T-cell-mediated attack of recipient tissues.

GVHD is more common following bone marrow transplantation but it can also occur when the organ being transplanted is rich in lymphoid cells (like the liver). Typical manifestations of GVHD include diarrhea, skin rash, and jaundice as donor T-cells typically target the gastrointestinal tract, skin, and liver, respectively. A colonoscopy and colonic biopsy can be used in the detection of GVHD in the gut.

Heidelbaugh and Sherbondy review chronic liver failure. Liver transplantation should be considered when medical therapy for advanced cirrhosis has failed. Recent advances in immunosuppression and risk stratification of potential transplant recipients has improved long-term survival rates of recipients.

Salmasian et al. review the treatment of GVHD after allogenic stem cell transplantation and conclude that there is insufficient evidence to determine the appropriate dosing regimens of corticosteroids for acute GVHD. Typical treatment of GVHD consists of immunosuppression with corticosteroids (prednisone), cyclosporine, azathioprine, monoclonal Ab to T lymphocytes (antithymocyte globulin), or methotrexate.

Illustration A depicts the typical skin findings of GVHD. The rash is often maculopapular. If chronic, it may be violaceous, excavating, and elevated.

Incorrect Answers:
Answers 2, 4, and 5: Recipient cells and antibodies are not involved in the pathogenesis of GVHD.
Answer 3: Donor B-cells have not been found to be responsible for GVHD.