Background. Hematopoietic stem cell transplantation has become an established procedure worldwide. Severe early and late complications are well described. Little is known about more subtle changes in general health status of very long term survivors. To assess health status of very long term survivors in comparison with their respective human leukocyte antigen-identical sibling donors. Design and methods: Case matched comparison in a cross-sectional cohort performed in a tertiary university hospital and referral center for hematopoietic stem cell transplantation. Forty four pairs of recipients and their respective donors with a very long term (17.5 years median; 11-26 years range) follow-up after allogeneic hematopoietic stem cell transplantation were included. A comparative clinical evaluation and examination of routine clinical chemistry tests was done. Results. Recipients had more frequently a lower Karnofsky score (p=0.05), hypertension (p=0.015) and dyslipidemia (p=0.002) but were less likely to be smokers (0.016). Recipients showed systematically lower glomerular filtration rates (p<0.0001), higher liver function tests (p=0.0004 for Aspartat-Amino-Transferase) and reduced thyroid function (p=0.002) despite normal or near normal values and independent of presence or absence of chronic graft-versus-host disease. Indicators of inflammation were more frequent in recipients (9/44) with ongoing chronic graft-versus-host disease as measured by higher c-reactive protein (p=0.001) and higher von Willebrand factor (p=0.002). Conclusions. Clinically very long term survivors after an allogeneic hematopoietic stem cell transplantation present more frequently with cardiovascular risk factors and with subtle signs of altered organ function compared to their sibling donors. Even minimal ongoing chronic graft-versus-host disease remains associated with elevated laboratory indicators of inflammation. The clinical significance of these findings needs to be defined.