Graft-versus-host disease occurs in which transplant settings and what are hallmark signs?

• A. Bone marrow and liver transplants; maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea
• B. Kidney transplants; acute tubular necrosis
• C. Pancreas transplants; pancreatitis
• D. Heart transplants; arrhythmias

Answer: (A)

Graft-versus-host disease happens when donor immune cells attack the recipient’s tissues after transplantation, most classically after allogeneic hematopoietic stem cell (bone marrow) transplants. It can also occur in liver transplants because of donor passenger lymphocytes, which is why bone marrow and liver settings are the ones associated with GVHD. The hallmark signs reflect multi-organ involvement: a maculopapular skin rash, jaundice from liver involvement (often with hepatosplenomegaly), and gastrointestinal symptoms such as diarrhea. Other transplant settings like kidney, pancreas, or heart don’t typically produce this GVHD pattern, and the listed complications (acute tubular necrosis, pancreatitis, arrhythmias) are not characteristic of GVHD.