What criteria should I use to determine whether a patient with GvHD requires referral to a specialist for further management?

Criteria for referral of a patient with graft-versus-host disease (GVHD) to a specialist include:

• Severity and extent of GVHD symptoms: Patients exhibiting moderate to severe symptoms affecting skin, liver, gastrointestinal tract, or other organs should be referred for specialist management.
• Presence of complications or treatment resistance: If GVHD is refractory to initial treatment or complicated by infections or organ dysfunction, specialist input is required.
• Need for advanced immunosuppressive therapy or clinical trials: Referral is indicated when patients require therapies beyond standard first-line treatments.
• Uncertainty in diagnosis or atypical presentation: Specialist assessment is necessary if the diagnosis is unclear or if symptoms do not follow typical patterns.

In general practice, early referral to a haematologist or transplant specialist is advised when GVHD is suspected or confirmed, especially if systemic involvement or severe symptoms are present, to ensure timely and appropriate management.