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Late liver effects following allogeneic‐HCT include cGVHD, viral hepatitis, and drug‐induced hepatitis. Liver biopsies obtained from cGVHD patients have indicated chronic persistent hepatitis, lobular hepatitis, and reduction of small bile ducts with cholestasis, which resembles the pathologic manifestations of primary biliary cirrhosis. Untreated hepatic GVHD may lead to liver failure, which carries a very high mortality. Periodic evaluation with liver function tests (LFTs) may help in early diagnosis. Hepatitis B and C reactivations post‐HCT are rare, but a diagnostic workup must include the viral serology to exclude these conditions.

Some 7–64% of cancer patients utilize some form of complementary and alternative medicine (CAM) therapies, though a literature gap exists concerning this issue in the field of HCT. Many CAM therapies are known to be hepatotoxic and, in some cases, may lead to hepatic failure. Some of the more frequently reported hepatotoxic CAM therapies include the Chinese remedies [29], mistletoe [30], and kava [31]. Efforts should be made to obtain comprehensive CAM history and appropriate advice should be provided to those HCT patients who are using hepatotoxic CAM therapies to potentially avoid the possibly fatal late effect of hepatic failure.

Approximately one‐third of HCT survivors have evidence of iron overload [32] due to chronic transfusions during the pre‐ and peri‐HCT period that may lead to secondary hemochromatosis. It may be reasonable to evaluate serum ferritin levels at 6–12 months post‐HCT; and for patients in whom the evidence of iron overload is found, the general principles of secondary hemochromatosis should be applied for organ‐specific screening for complications (e.g., surveillance with ultrasound for liver cancers). Patients with evidence of significant iron overload can be considered for therapeutic phlebotomy if there is an adequate recovery of erythropoiesis or possibly for iron chelation therapy.