Graft Versus Host Reaction

A common and serious, complication of bone marrow transplantation where there is a reaction of donated bone marrow against a patient's own tissue.

When donor lymphocytes or a graft containing lymphocytes that are immunologically competent are given to a patient that has low immunological competence, an incompatibility reaction can result. This is due to antibodies from the donor against antigens in the host. This is due to mismatch of MHC Class I antigens and can produce lymphocyte clones that will react by a variety of processes against the host and cause damage.

The clinical condition can be fatal and is due to the donor's immune cells recognising the host cells as foreign.

The clinical entity characterised by anorexia, diarrhoea, loss of hair, leukopenia, thrombocytopenia, growth retardation, and eventual death brought about by the graft-versus-host reaction. It can occur in either chronic or acute forms and is treatable by immunosuppressive drugs.

Seen most commonly following bone marrow transplantation, acute disease is seen after 5-40 days and chronic disease weeks to months after transplantation, affecting, principally, the gastrointestinal tract, liver, and skin.

Radiological appearances of the gastrointestinal tract include; thickened wall, mucosal folds thickened or effaced, increased secretions most likely to be rapid transit of GI tract, mass most likely to be focal oedema, fibrosis, hallmark: diffuse, uniform thickening of small bowel.