Which organ systems are commonly affected in acute graft-versus-host disease?

• A. Skin, liver, and gastrointestinal tract
• B. Heart, kidneys, and lungs
• C. Brain, spinal cord, and nerves
• D. Spleen, lymph nodes, and bone marrow

Answer: (A)

Acute graft-versus-host disease arises when donor T cells attack recipient tissues after an allogeneic transplant. The organs most commonly affected are the skin, liver, and gastrointestinal tract. Skin involvement typically presents with a diffuse maculopapular rash that can progress; liver involvement causes cholestatic injury with rising bilirubin and liver enzymes; and GI involvement leads to diarrhea and abdominal pain from mucosal injury. These tissues are especially vulnerable because they present abundant donor T-cell targets and have rapidly renewing epithelium, making them prime sites for immune-mediated damage in the acute period (usually within the first few months after transplant). While other organ systems can be involved, the triad of skin, liver, and GI tract is the classic pattern for acute GVHD.