Graft-versus-host disease

Graft-versus-host disease, abbreviated as GVHD, is a rare thingy seen mostly in tertiary care centres. It is a complication of hematopoietic stem cell transplantation.

General

• Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT).
• The histology of GVHD in the intestine is the same as rejection in bowel transplantation.

Clinical:

• May present as diarrhea.
• Main DDx (clinical): infection.

Microscopic (intestine)

Features:

• Isolated epithelial cell apoptosis - key feature.
• +/-Crypt destruction (focal or extensive).
• +/-Loss of epithelium (denudation).

Notes:

• Neutrophils should not be present.

Images:

• GVHD grade 1-4 (nature.com).

Grading

• Grade 1 = isolated epithelial cell apoptosis.
  • No crypt loss/destruction.
• Grade 2 = individual crypts are lost/scatter destruction of single crypts.
• Grade 3 = foci several adjacent crypts lost.
• Grade 4 = large number of adjacent crypts lost/loss of epithelium.

Notes:

• Low-grade rejection is a diagnosis that requires a careful examination, i.e. it is subtle.

See also

• Small bowel.
• Colon.
• Gastrointestinal pathology.