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graft-versus-host disease (GVHD)

The immune attack by lymphocytes in a donor's marrow or blood cell suspension (the graft) against the tissues of the recipient (the host). The immune cells most engaged in this reaction are donor T lymphocytes, which are present in the donor's blood or marrow, the source of the stem cells. The principal sites of injury are the skin, the liver and the gastrointestinal tract. The reaction does not occur in identical twin transplants. The reaction may be minimal in closely matched individuals or severe in less well-matched individuals. These reactions are mediated in part by antigens that are not in the major HLA system and cannot be matched prior to transplantation. For example, in the case of a female stem cell donor and a male recipient, factors that are produced by genes on the male recipient's Y chromosome may be seen as foreign by the female donor's cells, which do not share the genes on the Y chromosome. This fact does not prohibit female donors and male recipients, but it makes the risk of immune reaction higher.

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