Table 6. Hepatobiliary Late Effects
| Predisposing Therapy | Hepatic Effects | Health Screening/Interventions |
| ALT = alanine aminotransferase; AST = aspartate aminotransferase; HSCT = hematopoietic stem cell transplantation. | ||
| Methotrexate; mercaptopurine/thioguanine; HSCT | Hepatic dysfunction | Lab: ALT, AST, bilirubin levels |
| Ferritin in those treated with HSCT | ||
| Mercaptopurine/thioguanine; HSCT | Veno-occlusive disease/sinusoidal obstructive syndrome | Exam: scleral icterus, jaundice, ascites, hepatomegaly, splenomegaly |
| Lab: ALT, AST, bilirubin, platelet levels | ||
| Ferritin in those treated with HSCT | ||
| Radiation impacting liver/biliary tract; HSCT | Hepatic fibrosis/cirrhosis | Exam: jaundice, spider angiomas, palmar erythema, xanthomata hepatomegaly, splenomegaly |
| Lab: ALT, AST, bilirubin levels | ||
| Ferritin in those treated with HSCT | ||
| Prothrombin time for evaluation of hepatic synthetic function in patients with abnormal liver screening tests | ||
| Screen for viral hepatitis in patients with persistently abnormal liver function or any patient transfused prior to 1993 | ||
| Gastroenterology/hepatology consultation in patients with persistent liver dysfunction | ||
| Hepatitis A and B immunizations in patients lacking immunity | ||
| Consider phlebotomy and chelation therapy for iron overload | ||
| Radiation impacting liver/biliary tract | Cholelithiasis | History: colicky abdominal pain related to fatty food intake, excessive flatulence |
| Exam: right upper quadrant or epigastric tenderness (acute episode) | ||
| Consider gallbladder ultrasound in patients with chronic abdominal pain | ||
