What is the organ most commonly involved in graft-versus-host disease (GVHD), specifically the reaction of the graft against the host's body?

From the Guidelines

The answer is (d) skin, as it is the organ most commonly involved in graft-versus-host disease (GVHD), with skin manifestations typically appearing first and affecting up to 80% of patients with acute GVHD. The skin is particularly vulnerable because it contains numerous antigen-presenting cells that can activate donor T-cells, and it has a high turnover rate of epithelial cells which are easily recognized as foreign by donor lymphocytes 1. While GVHD can affect multiple organ systems including the liver and gastrointestinal tract, the skin remains the most frequently involved organ and often serves as the first clinical indicator of this serious transplant complication. Some key points to consider include:

• The skin, GI tract, and liver are the 3 organs primarily affected by acute GVHD, characterized by maculopapular rash, GI complications, and hyperbilirubinemia 1.
• Skin manifestations of GVHD can progress to blistering and desquamation in severe cases, and the skin is particularly vulnerable due to its high turnover rate of epithelial cells 1.
• The development of acute and/or chronic GVHD is a major complication of allogeneic HCT and is associated with significant morbidities and non-relapse mortality (NRM) in allogeneic HCT recipients 1.
• Management of GVHD can be optimized by providing coordinated care from a multidisciplinary team, preferably in medical centers with access to specialized transplant services 1.
• Graft-versus-host disease (GVHD) more frequently develops in patients after allogeneic bone marrow transplantation, with the skin and gastrointestinal tract being the most commonly affected areas 1.

From the Research

Graft-Versus-Host Reaction

The organ most commonly involved in graft-versus-host reaction is:

• Skin, as evidenced by multiple studies 2, 3, 4, 5, 6

Key Findings

• The skin is the most common target organ affected by graft-versus-host disease (GVHD) 2
• Skin is usually the first and most affected organ involved in graft-versus-host disease (GvHD) 3
• The clinical presentation of GVHD is varied and may resemble autoimmune diseases, such as scleroderma, lichen planus or lichen sclerosus, with the skin being the most commonly involved organ 4
• Cutaneous GVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections 6
• Skin-directed treatments for cGVHD, such as topical steroids, topical calcineurin inhibitors, and ultraviolet irradiation, can improve patient outcomes and quality of life 6