One of the keys to a successful solid organ (or tissue)transplant is convincing the recipient’s body to accept the donation. In these scenarios the body is a prowling tiger and the new tissue an alluring prey. Luckily, drugs  like Cyclosporin and Tacrolimus can tranquilize the beast and organ rejection can be prevented.

In bone marrow and stem cell transplants the roles are switched. A tiger is being introduced to a new and unfamiliar place. Bone marrow is responsible  for the creation of all blood cell lines including those white cells who recognize a foreign presence and eliminate it. The tiger is weary of its surroundings and inclined to attack. That assault is known as Graft vs. Host Disease(GVHD). Prevention requires those same drugs used to treat organ rejection.

My first signs of GVHD showed up three weeks after transplant in the acute phase, which generally occurs in the first 100 days post transplant. It was calmed with steroids.

Now, six months out of transplant, any manifestations of GVHD are generally considered chronic. Given the number of medications and toll treatment takes on your body, GVHD is difficult to self diagnose. Signs present in a variety of places including skin, nails, hair, stomach, mouth, eyes, and organs. A transplant patient wisely warned me, ‘tell your doctors everything, even if it seems stupid, the last thing you want is a flair to go untreated.’

Months back a nurse offered this explanation of Graft vs. Host: Imagine two little kids in a sand box. One kid represents the  donor’s marrow, the other is the recipient’s body. Little kids don’t always get along. Tempers flair and fights break out. This could happen only once or twice, or it could takes awhile—even years— for the kids to mature enough to coexist. But sooner or later kids tame their antics and  become best friends(smiles all around).

The allegory of kids and sunny day sandbox interactions and a deer sipping water from a cool stream off in the background all set to the soothing sounds of Kenny G, is agreeable but unfinished. There off to the left in the woods, behind Kenny is a tiger lurking, and nurse, he is the one who needs to be tamed.

Kenny G, courtesy of Wikipedia

Kenny G lulling the masses, courtesy of Wikipedia


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