What is most likely mediating these symptoms?

A 40-year-old male with a history of chronic alcoholism recently received a liver transplant. Two weeks following the transplant, the patient presents with a skin rash and frequent episodes of bloody diarrhea. A colonoscopy is performed and biopsy reveals apoptosis of colonic epithelial cells. What is most likely mediating these symptoms ?

1.Donor T-cell
2.Recipient T cells
3.Donor B cells
4.Recipient B-cells
5.Recipient antibodies

sol:

The patient in the question is suffering from graft-versus-host disease (GVHD) following liver transplantation. In GVHD there is donor T-cell-mediated attack of recipient tissues.

GVHD is more common following bone marrow transplantation but it can also occur when the organ being transplanted is rich in lymphoid cells (like the liver). Typical manifestations of GVHD include diarrhea, skin rash, and jaundice as donor T-cells typically target the gastrointestinal tract, skin, and liver, respectively. A colonoscopy and colonic biopsy can be used in the detection of GVHD in the gut.

Heidelbaugh and Sherbondy review chronic liver failure. Liver transplantation should be considered when medical therapy for advanced cirrhosis has failed. Recent advances in immunosuppression and risk stratification of potential transplant recipients has improved long-term survival rates of recipients.

Illustration A depicts the typical skin findings of GVHD. The rash is often maculopapular. If chronic, it may be violaceous, excavating, and elevated.