Transplant pathology: graft versus host disease: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Transplant pathology: graft versus host disease

Sample item

Three weeks after allogeneic bone marrow transplantation for leukaemia, a patient develops a maculopapular rash, watery diarrhoea and raised bilirubin. Which cells mediate this complication?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Donor T lymphocytes attacking host tissues

Acute graft-versus-host disease occurs when immunocompetent donor T cells recognise host HLA antigens as foreign, damaging skin, gut and liver (bile duct injury). It is a risk in immunosuppressed hosts receiving allogeneic marrow. Rejection by the host, by contrast, involves recipient immunity against the graft.

Option by option

  • A. Recipient T lymphocytes attacking donor marrow

    Recipient T cells attacking the graft describes graft rejection.

  • B. Recipient natural killer cells

    Recipient NK cells are not the effectors of GVHD.

  • C. Preformed recipient antibodies against donor HLA

    Preformed antibodies cause hyperacute rejection of solid organs within minutes.

  • D. Donor T lymphocytes attacking host tissues (correct)

    Donor T cells in the graft attack host epithelial tissues.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Donor T lymphocytes attacking host tissues. Acute graft-versus-host disease occurs when immunocompetent donor T cells recognise host HLA antigens as foreign, damaging skin, gut and liver (bile duct injury).

Why is "Recipient T lymphocytes attacking donor marrow" not the answer?

Recipient T cells attacking the graft describes graft rejection.

Why is "Recipient natural killer cells" not the answer?

Recipient NK cells are not the effectors of GVHD.

Why is "Preformed recipient antibodies against donor HLA" not the answer?

Preformed antibodies cause hyperacute rejection of solid organs within minutes.

What concept does this question test?

It tests Transplant pathology: graft versus host disease in Pathology. It is a risk in immunosuppressed hosts receiving allogeneic marrow. Rejection by the host, by contrast, involves recipient immunity against the graft.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Transplant pathology: graft versus host disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.