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Gastrointestinal or hepatic

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HCT survivors have a >5‐fold burden of significant gastrointestinal (GI) complications compared to other cancer survivors which may include strictures of the esophagus and lower GI tract [62]. Strictures are most frequently due to cGVHD, prior candida esophagitis, GERD, or radiation >30 Gy; symptoms may include dysphagia and heartburn. Focal nodular hyperplasia is an often incidental benign finding, best diagnosed on gadolinium‐enhanced MRI and usually just needs to be monitored to avoid unnecessary invasive procedures [63,64]. Liver dysfunction due to GVHD, sequela of prior sinusoidal obstruction syndrome, hepatotropic viruses and iron overload may present with LFT abnormalities or hepatic synthetic defects. Chronic hepatitis B and C can lead to cirrhosis, portal hypertension and hepatocellular carcinoma. Unless GVHD is present at other sites, a liver biopsy might be indicated to confirm a liver GVHD diagnosis. Iron overload may exacerbate any LFT abnormality and so persistent elevation of serum ferritin might warrant checking transferrin saturation and possibly T2*MRI imaging to quantitate liver iron. Patients with significant LFT abnormalities should limit alcohol intake and avoid other hepatotoxins.

Blood and Marrow Transplantation Long Term Management

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