Hepatic Complications of Bone Marrow Transplantation

Hepatic complications of hematopoietic stem cell transplantation (HSCT) are common. Sinusoidal obstruction syndrome (SOS), acute/chronic hepatic graft-versus-host disease (HGVHD), infection and drug-induced hepatotoxicity (DIH) are the most common reasons for liver abnormalities following HSCT. SOS, characterized by rapid weight gain due to fluid retention, hyperbilirubinemia, and hepatomegaly with right upper quadrant pain, can be difficult to diagnose. Liver biopsy is the gold standard. Treatment options include tissue-type plasminogen activator with heparin, defibrotide, and antithrombin III. A majority of patients recover. Acute HGVHD generally occurs with skin and gastrointestinal tract GVHD. Chronic HGVHD presents with other manifestations of chronic GVHD, closely resembling an autoimmune disorder much like scleroderma. Immunosuppression is the mainstay of therapy, with a majority of patients requiring long-term treatment. Viral, fungal and bacterial infections, as well as DIH, are also common after HSCT. Treatment with appropriate antibiotics, or withholding liver-toxic medications, results in liver function improvement for most patients.