Hepatotoxicity in the peri-HSCT period

Hepatotoxicity in the peri-hematopoietic stem cell transplantation (HSCT) period is relatively common with an incidence of approximately 80%. Because the liver plays such a central role in the metabolism of drugs; elimination of toxins; detoxification of metabolic waste products; synthesis of key proteins, such as albumin and clotting factors; bile production; the storage of vitamins A, D, E, and K; as well as the synthesis, metabolism, and/or storage of carbohydrates, proteins, and fats, liver damage during any phase of HSCT can cause a significant degree of morbidity and mortality. The most common causes of HSCT-related hepatotoxicity that occur during the peri-HSCT period include the chemotherapy and/or irradiation used in conditioning regimens, medications commonly used during the peri-HSCT period (e.g., immunosuppressants and antibiotics), total parental nutrition (TPN), iron overload, and infection/sepsis. The most common hepatic complications during the peri-HSCT period are transaminitis, sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD), acute graft versus host disease (GvHD) of the liver, and infections involving the liver. Because infections and acute GvHD are addressed in detail in other chapters (see Chaps. 17 and 18, respectively), this chapter will focus primarily on transaminitis and SOS.