Late Effects of Bone Marrow and Stem Cell Transplant on Organs and Tissues

Bone marrow and stem cell transplantation can cause difficulties with heart, lungs and other organs years later. 

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Some of the drugs used in the preparative regimen, as well as total body irradiation and chronic graft-versus-host disease, may affect your organs. In most cases, the organ damage is temporary and reversible. 

The list of possible organ problems may seem overwhelming, but keep in mind that no one experiences all of them, and some people experience none at all.

Your transplant program should give you a list of ongoing tests you should have to ensure that your organs remain healthy after transplant.

Below are some, but not all, of the organs that may be affected.

Vision Problems after Transplant

Cataracts are a common side effect of transplant. If you develop a cataract, it can be surgically removed in an outpatient setting.

If you had chronic graft-versus-host disease (GVHD), you may experience dry eyes and other vision problems after transplant. 

Click here to learn more about eye problems caused by graft-versus-host disease..

Dental Problems after Transplant

Total body irradiation, infection, medications used during transplant and chronic GVHD can cause dry mouth, tooth decay, loose teeth and tooth loss

Prescription toothpaste with high fluoride content, such as Prevident®, or fluoride rinses provided by your dentist may help prevent dental problems after transplant.

Frequent follow-up with a dentist and an annual screening for oral cancer is important to prevent serious issues.

Click here to learn about oral problems caused by graft-versus-host disease.

Bone Health after Transplant


Transplant recipients often experience a significant decline in bone density during the few first years after transplant. This increases the risk of fractures due to osteoporosis.

Osteoporosis is often a ‘silent disease’ with no symptoms until a fracture occurs. A number of strategies can slow the progression of osteoporosis such as:

  • use of bisphosphonates
  • adequate intake of calcium
  • weight-bearing exercise
  • smoking cessation.

Avascular Necrosis

Avascular necrosis (loss of blood flow to the bone) occurs in 5-20 percent of patients who had a transplant with donor cells. The risk is greatest among those who:

  • are older
  • had aplastic anemia or leukemia
  • received total body irradiation
  • had GVHD that was treated with steroids

Avascular necrosis usually affects the hips or knees. In mild case, exercise may help. More severe cases require surgery to replace the joint.

Talk with your doctor about monitoring your bone health after transplant.

Watch a video about bone health after transplant.

Heart Health after Transplant

Transplant recipients have a two-to-four times greater risk of developing cardiovascular disease than the general population, especially those who were treated with radiation, doxorubicin (Adriamycin®) or cyclophosphamide (Cytoxan®).

Heart problems typically occur 5-10 years after transplant and tend to develop at a younger age than the general population.

To protect your heart:

  • Have regular check-ups for blood pressure, diabetes and cholesterol.
  • Exercise regularly. Even moderate exercise helps.
  • Do not smoke.
  • Eat a low-fat diet to maintain a healthy weight.

Watch a video about heart health after transplant.

Thyroid Issues after Transplant

Hypothyroidism (underactive thyroid) is common after transplant. 

When the thyroid gland does not make enough thyroid hormone, it can cause fatigue, weight gain and/or sensitivity to cold.It can aso affect growth in children.

There are effective treatments for hypothyroidism. Left untreated, hypothyroidism can lead to obesity, joint pain and/or heart disease.

Ask your doctor to check your thyroid function annually.

Lung Problems after Transplant

Bronchiolitis obliterans syndrome, also called GVHD of the lungs, occurs in approximately 5% of transplant recipients and 15% of those who have GVHD in another organ.

Click here to learn more about brochiolitis obliterans syndrome.

Kidney Problems after Transplant

Kidney disease can occur following transplant. The risk of kidney disease is greatest among patients who:

  • have multiple myeloma
  • were treated with total body irradiation (TBI)
  • have chronic GVHD

Treatment for kidney disease varies depending on the type of kidney problem you have. Blood and urine tests can help detect kidney problems. If you have kidney problems, be sure to talk with your doctor about all medications you take, including herbal supplements, as some can make the problem worse.

Liver Problems after Transplant

Some patients who received many blood transfusions before or during transplant can develop iron overload - too much iron in your blood. Iron overload can:

  • increase your risk of infection
  • affect the health of your liver and heart

Iron overload is most common in people who have had multiple red blood cell transfusions before and after transplant such as patients with myelodysplastic syndrome (MDS), severe aplastic anemia, thalassemia and sickle cell disease. 

Iron overload is typically treated by removing some of your blood through a process called phlebotomy. The procedure is similar to that used when you donate blood. 

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Updated June 2024