ABSTRACT
Hematopoietic stem cell transplantation (SCT) subjects the liver to numerous potential
insults. The types of injury fall into the broad categories of infection, toxic damage due to
medication, recurrence of the primary disease, and immunologically mediated injury (1)
(Table 1). Liver toxicity is commonly attributed to the cytoreductive therapy used during
induction for SCT and may take the form of generalized impairment of liver function in
the immediate posttransplantation period (2), such as venoocclusive disease (VOD), or nod-
ular regenerative hyperplasia months later (3,4). Systemic infections involving the liver or
infections by hepatotrophic viruses are ever-present threats. Emerging from this morass of
potential problems is the clinical syndrome of graft-vs.-host disease (GVHD), featuring, to
varying degrees, skin rashes, diarrhea, weight loss, and predominantly cholestatic liver dys-
function. GVHD involving the liver is a frequent complication after SCT, and this chapter
will address features of this form of hepatic dysfunction.
