Micrographs of grades of skin<unk> : Ranging from grade I<unk> R (with minimal vacuolization in the epidermis) to grade II<unk> R (with vacuolization and dyskeratotic bodies) to grade III<unk> R (with sub epidermal cleft formation) and finally to grade IV<unk> R (with separation of the dermis from the epidermis). In the clinical setting,<unk>  is divided into acute and chronic forms, and scored or graded on the basis of the tissue affected and the severity of the reaction. In the classical sense, acute<unk>  is characterized by selective damage to the liver, skin (rash), mucosa, and the gastrointestinal tract. Newer research indicates that other<unk>  target organs include the immune system (the hematopoietic system, e.g., the bone marrow and the thymus) itself, and the lungs in the form of immune-mediated pneumonitis. Biomarkers can be used to identify specific causes of<unk> D, such as elafin in the skin. Chronic<unk>  also attacks the above organs, but over its long-term course can also cause damage to the connective tissue and exocrine glands. Mucosal damage to the vagina can result in severe pain and scarring, and appears in both acute and chronic<unk> D. This can result in an inability to have sexual intercourse. Acute The acute or fulminant form of the disease (aGvHD) is normally observed within the first 10 to 100 days post-transplant, and is a major challenge to transplants owing to associated morbidity and mortality. About one-third to one-half of allogeneic transplant recipients will develop acute<unk> D. It's less common in younger patients and in those with closer human leukocyte antigens (HLA) matches between donor and the patient. The first signs are usually a rash, burning, and redness of the skin on the palms and soles. This can spread over the entire body. Other symptoms can include Nausea, vomiting, stomach cramps, diarrhea (watery and sometimes bloody), loss of appetite, jaundice, abdominal pain, and weight loss. Acute<unk> D of the GI tract can result in severe intestinal inflammation, sloughing of the mucosal membrane, severe diarrhea, abdominal pain, nausea, and vomiting. This is typically diagnosed via intestinal biopsy. Liver<unk> D is measured by the bilirubin level in acute patients. Skin<unk> D results in a diffuse red maculopapular rash, sometimes in a lacy pattern. Acute<unk> D is staged as follows: overall grade (skin-liver-gut) with each organ staged individually from a low of 1 to a high of 4. Patients with grade IV<unk> D usually have a poor prognosis. If the<unk> D is severe and requires intense immunosuppression involving steroids and additional agents to get under control, the patient may develop severe infections as a result of the immunosuppression and may die of infection. However, a 2016 study found that the prognosis for patients with grade IV<unk> D has improved in recent years. Chronic The chronic form of<unk>  (cGvHD) normally begins 90 to 600 days post-transplant. The appearance of moderate to severe cases of cGVHD adversely influences long-term survival. The first symptom of cGvHD is commonly a rash on the palms of the hands or the soles of the feet, and the rash can spread and is usually itchy and dry. In severe cases, the skin may blister and peel, like a bad sunburn. A fever may also develop. Other symptoms of chronic<unk> D can include: * Decreased appetite * Diarrhea * Abdominal (belly) cramps * Weight loss * Yellowing of the skin and eyes (jaundice) * Enlarged liver * Bloated abdomen (belly) * Pain in the upper right part of the abdomen (belly) * Increased levels of liver enzymes in the blood (seen on blood tests) * Skin that feels tight * Dry, burning eyes * Dryness or painful sores in the mouth * Burning sensations when eating acidic foods * Bacterial infections * Blockages in the smaller airways of the lungs In the oral cavity, chronic<unk>  manifests as lichen planus with a higher risk of malignant transformation to oral squamous cell carcinoma in comparison to the classical oral lichen planus. Oral cancer associated with<unk>  may have more aggressive behavior with poorer prognosis, when compared to oral cancer in non-hematopoietic stem cell transplantation patients.
Graft-versus-host disease
Transplant rejection
Cardiac allograft vasculopathy
Vasculogenic mimicry
Infectious tolerance
Disseminated disease
Chronic allograft nephropathy
Post-transplant lymphoproliferative disorder