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Liver Immunology pp 409–421Cite as

Hepatic Complications of Hematopoietic Cell Transplantation

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Abstract

In no other medical situation is a patient at risk for so many liver diseases as during a hematopoietic cell transplant (HCT). The preparation for transplant includes either liver-toxic myeloablative therapy or intense immunosuppression that allows host microchimerism with allogeneic donor hemaotpoietic cells. As a result, patients are profoundly immunosuppressed until engraftment of infused hematopoietic stem cells; full recovery of immune function is often delayed for a year or longer; and infection with viruses, fungi, and bacteria is common. Recipients of allogeneic stem cells are also at risk for graft-versus-host disease (GVHD) involving the liver, and some patients who have received autologous or syngeneic stem cells may also develop bile duct injury resembling GVHD. Thus, a patient undergoing transplant is at risk for toxic, infectious, and immunologic liver injury. Jaundice after transplant is an ominous prognostic sign, with total serum bilirubin in the 4 to 7 mg/dL range conferring 50% mortality and bilirubin values more than 10 mg/dL conferring more than 70% mortality at d 200 posttransplant (1). Fortunately, the incidence of serious liver injury following transplant has fallen dramatically over the last decade, for several reasons.

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Authors and Affiliations

  1. Pathology Section, Fred Hutchinson Cancer Research Center, The Seattle Cancer Care Alliance, USA

    Howard M. Shulman MD

  2. The University of Washington School of Medicine, Seattle, WA

    Howard M. Shulman MD & George B. McDonald MD

  3. Gastroenterology/Hepatology Sections, Fred Hutchinson Cancer Research Center, USA

    George B. McDonald MD

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Editors and Affiliations

  1. Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, CA

    M. Eric Gershwin MD, FACP

  2. Departments of Medicine and Surgery Baylor Liver Health, Baylor College of Medicine, Houston, TX

    John M. Vierling MD, FACP

  3. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School of Hannover, Hannover, Germany

    Michael P. Manns MD

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Shulman, H.M., McDonald, G.B. (2007). Hepatic Complications of Hematopoietic Cell Transplantation. In: Gershwin, M.E., Vierling, J.M., Manns, M.P. (eds) Liver Immunology. Humana Press. https://doi.org/10.1007/978-1-59745-518-3_32

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