Gastrointestinal and hepatic complications of hematopoietic stem cell transplantation

Table 5 Differential diagnosis for liver function abnormalities after hematopoietic stem cell transplantation

First 3 wk post-transplant

Drug toxicity

Conditioning regimens (cyclophosphamide, total body irradiation, bis-chloroethylnitrosourea, busulfan)

Calcineurin inhibitors

Azole antifungals

SOS

Sepsis, candidiasis

Ischemic liver disease

From 3 wk to 3 mo post-transplant

Acute GVHD

Drug toxicity

SOS

Hepatitis (fulminant, acute or chronic):

Viral (HBV, HCV, HSV, VZV, adenovirus) reactivation

Bacterial or fungal Infection

Fungal abscess

Gall bladder disease/cholecystitis

Hyperalimentation

Post-transplant lymphoproliferative disorder (EBV-related)

After 3 mo post-transplant

Chronic GVHD

Iron overload

Chronic viral hepatitis

Drug toxicity

Liver fibrosis or cirrhosis:

SOS

Viral infections

Hemosiderosis

Disease recurrence or new malignancy including hepatocellular carcinoma, lymphoproliferative disorder

Nodular regenerative hyperplasia

Gallbladder disease

GVHD: Graft-versus-host disease; SOS: Sinusoidal obstruction syndrome; EBV: Epstein-Barr virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HSV: Herpes simplex virus; VZV: Varicella zoster virus.