Graft-versus-host disease most commonly arises after which type of transplantation?

• A. Kidney allograft
• B. Bone marrow/hematopoietic stem cell transplant
• C. Liver transplant
• D. Corneal transplant

Answer: (B)

Graft-versus-host disease happens when donor immune cells in the transplant attack the recipient’s tissues. This requires a graft that brings functional donor T cells into the recipient, which then recognize host antigens as foreign and initiate an immune attack on multiple organs.

This scenario is most likely after bone marrow or hematopoietic stem cell transplantation because these grafts deliver large numbers of mature donor T lymphocytes. In contrast, solid organ transplants like kidney or liver, or even corneal transplants, carry far fewer donor T cells and, in the case of the cornea, benefit from immune privilege, making GVHD far less common.