Written by:Bilal HasdemirFact check:

Overview

What Is Graft Disease?

Graft disease usually refers to graft-versus-host disease (GVHD), a complication that can occur after an allogeneic stem cell or bone marrow transplant. In GVHD, immune cells from the donor’s graft recognize the recipient’s tissues as foreign and attack them. It can affect the skin, digestive tract, liver, eyes, mouth, lungs, joints, and other tissues, but not every transplant recipient develops it.

Symptoms

Symptoms of Graft Disease

  • A red, itchy, painful, or blistering skin rash (cutaneous GVHD).
  • Persistent or watery diarrhea.
  • Nausea or vomiting.
  • Yellowing of the skin or eyes from liver involvement (jaundice).
  • Dryness, sores, or pain in the mouth.
  • Dry, gritty, painful, or light-sensitive eyes.
  • Stiffness or reduced movement in the joints.
  • A dry cough or shortness of breath from lung involvement.

IMPORTANT

Report new symptoms promptly

Symptoms may appear days to months after transplant and can vary depending on the organs involved and whether GVHD is acute, chronic, or overlapping. Report new or worsening symptoms to the transplant team promptly rather than waiting for the next scheduled visit.

Causes

What Causes Graft Disease?

Graft disease occurs when immunocompetent donor T cells in an allogeneic graft identify the transplant recipient’s tissues as foreign. Genetic differences between donor and recipient, including differences in human leukocyte antigens (HLA), can trigger this immune response even when the transplant is carefully matched.

Acute and Chronic Graft-Versus-Host Disease

Acute GVHD often affects the skin, digestive tract, and liver and may develop relatively soon after transplant, while chronic GVHD can involve the skin, mouth, eyes, lungs, joints, fascia, and other organs. Chronic disease may resemble autoimmune or scarring conditions and can persist or develop later. Timing is helpful, but clinicians also consider the pattern of organ involvement and immune features; some people have overlap GVHD with acute and chronic characteristics.

Risk Factors

Risk Factors for Graft Disease

  • A greater donor-recipient HLA mismatch can increase the likelihood of GVHD.
  • An unrelated donor or a partially matched donor may carry more risk than a closely matched related donor.
  • Donor age and certain donor-recipient sex differences may affect risk in some transplant settings.
  • Older recipient age is associated with a higher risk of complications after transplant.
  • Prior sensitization, such as exposure to transfusions, pregnancy, or a previous transplant, may influence immune compatibility.
  • The type of transplant, graft source, conditioning regimen, and amount of donor immune cells can affect risk.
  • The recipient’s underlying illness, overall health, and prior treatments may also influence susceptibility and severity.

Factors That May Reduce Risk

Transplant specialists may reduce risk through careful donor selection, conditioning choices, graft processing, and preventive immunosuppressive medicines. These measures lower risk but cannot prevent every case, and patients should never stop or change transplant medicines without guidance from their transplant team.

Complications

Complications of Graft Disease

  • Severe skin or mucosal disease can cause painful inflammation, blistering, sores, or scarring.
  • Digestive symptoms may lead to dehydration, weight loss, or malnutrition.
  • Liver involvement can cause inflammation, jaundice, and impaired liver function.
  • Lung involvement may cause persistent cough, breathing problems, or reduced oxygen exchange.
  • Chronic inflammation and scarring can cause contractures, stiffness, or reduced mobility.
  • Eye complications may include severe dryness, pain, light sensitivity, or vision changes.
  • GVHD and its treatment can increase the risk of bacterial, viral, fungal, and other infections.

Diagnosis

How Graft Disease Is Diagnosed

Diagnosis is based on the pattern and timing of symptoms after an allogeneic transplant, together with a physical examination and test results. Clinicians also work to rule out infections, medication reactions, disease relapse, and other causes that can look like graft-versus-host disease.

  • The skin, mouth, eyes, and digestive tract may be examined for characteristic changes.
  • Blood tests can assess liver function, inflammation, and changes in blood-cell counts.
  • Stool studies and other infectious tests may help identify infection as a cause of diarrhea or other symptoms.
  • Imaging or lung-function tests may assess breathing symptoms and organ involvement.
  • A tissue biopsy of the skin, digestive tract, or another affected area may be used when the diagnosis is uncertain or additional information is needed.

DIAGNOSIS NOTE

Classification guides treatment

The transplant team may grade or classify GVHD according to the organs affected and the severity of changes. A biopsy is not always required before treatment when the clinical picture is clear and delaying treatment could be harmful.

Treatment & Management

Treatment and Management of Graft Disease

Initial Treatment and Supportive Care

Treatment depends on whether GVHD is acute, chronic, or overlapping, as well as its severity, affected organs, and the person’s overall health. Corticosteroids or other immune-suppressing medicines may be used, with regular monitoring for response and side effects. Care may also include skin and mouth care, nutrition and hydration support, physical or occupational therapy, and measures to prevent and promptly treat infections.

Treatment for Persistent or Refractory Disease

  • Targeted or pathway-directed medicines may be recommended when GVHD does not respond adequately to initial therapy.
  • Extracorporeal photopheresis may be appropriate for selected people, particularly with certain persistent or chronic disease patterns.
  • Clinical trials may provide access to emerging treatments under specialist supervision.
  • Organ-specific rehabilitation, including eye, mouth, lung, skin, joint, or nutrition care, can help manage lasting effects and improve function.

Outlook and Prognosis

Outlook and Prognosis for Graft Disease

The outlook for graft disease varies widely. Mild disease may respond well to treatment, while severe or persistent GVHD can damage several organs and require prolonged immune-directed therapy. Prognosis is individualized and depends on the disease pattern, transplant history, complications, and response to treatment rather than on one factor alone.

  • Faster recognition and treatment of new symptoms may improve the chance of controlling inflammation.
  • The number of affected organs and the severity of their involvement influence outlook.
  • Response to initial and subsequent treatments is an important prognostic factor.
  • Infections and other complications can make recovery more difficult.
  • Chronic scarring or functional changes may persist even after active inflammation improves.
  • The ability to gradually taper immunosuppressive medicines can indicate improving disease control, although tapering must be medically supervised.

When Should You See a Doctor

When Should You See a Doctor?

CONTACT YOUR CARE TEAM

Report possible GVHD promptly

Contact the transplant team promptly for a new rash, persistent diarrhea, vomiting, jaundice, mouth or eye changes, shortness of breath, fever, reduced urination, or rapidly worsening symptoms. These signs may reflect GVHD, infection, dehydration, medication effects, or another complication that needs timely assessment.

Symptoms

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