Graft versus host disease

Graft versus host disease (GvHD) is a frequent complication of allogeneic post haematopoietic stem cell transplantation (HSCT), commonly known as bone marrow transplantation. Anti-rejection drugs have reduced the incidence, although it does still frequently occur. 

Pathology

GvHD can present early/acute (<100 days) or late/chronic (>100 days) post-HSCT, and is one of the major complications of this treatment. The skin, gastrointestinal tract (especially small bowel), and liver are the principal affected organs. Effects on the gastrointestinal tract are the most commonly described in the radiology literature.

End-organ damage is the result of recipient's immune system (mainly antigen presenting cells) interacting with donor T-cell, leading to the latter's activation with a resultant cell-mediated and inflammatory cascade 8. The pathophysiology of chronic GvHD is not well understood 

Radiographic features

Features depend upon the organ involved.

Fluoroscopy
Gastrointestinal tract

On small bowel barium studies, the bowel is described as having a "ribbon" appearance with fold thickening. Other described features are 5:

  • oedema of mucosal folds in ileum and jejunum
  • effacement of folds towards the ileum: can give featureless (atrophic) loops
  • thickening of the bowel wall
  • spasms and stenosis with prestenotic dilatation
  • in the active phase, the bowel can appear shortened
CT
Abdomen
Gastrointestinal tract

Described CT features include:

  • bowel wall thickening:
    • considered the most consistent finding
    • can affect small or large bowel or both (commonest 6
  • bowel dilatation 
  • mucosal enhancement 
  • engorgement of the vasa recta adjacent to affected bowel segments 3
  • gastric wall thickening 
Extra-intestinal findings in the abdomen 

Reported features include:

  • mesenteric stranding: ~60% 6
  • ascites 
  • biliary abnormalities  
  • urinary excretion of orally administered gastrografin 
Thorax 

See: thoracic manifestations of graft versus host disease

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Article information

rID: 24357
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Graft versus host disease (GvHD)
  • GvHD
  • Graft-verses host disease
  • Graft-verses host disease - general

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