Liver Complications After Chemotherapy: A Patient's Journey

Q: Liver Complications After Chemotherapy: A Patient's Journey

Hello： I would like to discuss the reasons for liver function deterioration. <br>Your attending physician must have pondered and searched for causes without success, which is why they responded that the cause of liver deterioration could not be identified. <br>(1) Infection (bact

Liver lesions caused by chemotherapy?

Hello, my father underwent surgical treatment for rectal cancer two years ago and was doing well.
However, he experienced a recurrence two years later and was transferred to the hematology department at the same hospital.
He has been taking oral chemotherapy and receiving weekly injections.
Before starting treatment, his liver enzyme levels were at 580.
The doctor recommended hospitalization for liver treatment, and once the levels dropped to 2.30, chemotherapy would commence.

Two weeks into treatment, he developed jaundice in mid-August, and despite not stopping the medication, his jaundice levels skyrocketed, reaching the twenties by early September and nearly thirty by the end of September.
He experienced severe edema and was hospitalized for treatment, but his condition worsened.
The attending physician mentioned that he could not determine the cause of the liver deterioration.

In early October, the attending physician informed the family that there was nothing more he could do.
He had previously assessed for hepatitis B or carriers, but two tests came back negative, indicating that my father's liver was already in poor condition.
By early October, he had developed pleural effusion and ascites, which were compressing his lungs and causing respiratory difficulties, leading to intubation and an inability to urinate.
The family decided to transfer him to the intensive care unit, where he underwent liver and kidney dialysis and abdominal drainage.

By mid-October, he regained consciousness and was able to communicate clearly, with liver enzyme levels dropping close to normal, although jaundice remained in the low twenties.
He successfully underwent a breathing test and had the tube removed.
However, at the end of October, he suddenly experienced massive bleeding, with blood pressure dropping to 5X/3X and elevated ammonia levels, leading to confusion.
The resident physician indicated that his condition was critical, but we did not want to give up and decided to proceed with intubation again.

After receiving blood transfusions, his blood pressure improved to 10X/5X, but the doctor stated that due to low blood pressure, he could not undergo liver or kidney dialysis.
His previous edema had subsided but returned, and today he started bleeding from the stoma, with blood pressure dropping again.
The resident physician mentioned that the only options now are blood transfusions and albumin injections.

I would like to inquire if there are truly no other options available? Is there a possibility for liver function recovery? Thank you, doctor!

Ting, 20~29 year old female. Ask Date: 2015/10/29

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: I would like to discuss the reasons for liver function deterioration.
Your attending physician must have pondered and searched for causes without success, which is why they responded that the cause of liver deterioration could not be identified.
(1) Infection (bacterial, viral, or tuberculosis infiltration) (2) Shock (septic shock or hemorrhagic shock) (3) Heart failure (4) Tumor metastasis to the liver (visible on imaging) or tumor infiltration of the liver (sometimes not easily seen on imaging) (5) Lymph node or intra-abdominal metastasis compressing the bile duct (6) Hepatotoxic medications.
The causes of liver function deterioration are certainly not limited to these, and sometimes multiple factors may contribute simultaneously.
Based on your description, your father has already exhibited multiple organ dysfunction.
Sometimes, there is no identifiable cause, and various organs in the body may sequentially show signs of functional decline.
Liver failure (ascites, low albumin, elevated blood ammonia, altered consciousness, coagulopathy leading to gastrointestinal bleeding) can occur similarly to renal failure or respiratory failure, where it is also difficult to pinpoint the cause.
I believe your attending physician understands the condition best, and it is not possible to diagnose the cause of your father's organ failure through written descriptions alone.
When liver failure occurs, medical interventions, such as liver dialysis, can only serve as a bridge during the liver's recovery process.
If liver function does not recover on its own, liver transplantation is the last and most effective step; however, tumor recurrence is a contraindication for transplantation.
I believe you must care deeply for your father, and I hope for his swift recovery.
Dr.
Tsai An-Shun, Changhua Hospital.

Reply Date: 2015/10/29

More Info

I'm truly sorry to hear about your father's challenging health situation. It sounds like he has been through a lot, and it's understandable that you are seeking clarity on his liver complications following chemotherapy.
Liver complications after chemotherapy can arise from several factors, especially in patients with pre-existing liver conditions or those undergoing aggressive cancer treatments. In your father's case, the initial high liver enzyme levels (580) indicated significant liver stress or damage, which is not uncommon in patients undergoing chemotherapy. The subsequent rise in bilirubin levels leading to jaundice, along with the development of ascites (fluid accumulation in the abdomen) and edema, suggests that his liver function has been severely compromised.

The fact that the medical team could not identify a specific cause for the liver deterioration is concerning. There are several potential reasons for liver dysfunction in this context, including:
1. Chemotherapy-Induced Hepatotoxicity: Some chemotherapy agents can be toxic to the liver, leading to elevated liver enzymes and bilirubin levels. This can result in acute liver injury, especially if the liver was already compromised.

2. Underlying Liver Disease: If your father had pre-existing liver conditions (such as fatty liver disease, hepatitis, or cirrhosis), these could have been exacerbated by the chemotherapy.

3. Infections: Infections, particularly viral hepatitis, can worsen liver function. Although tests for hepatitis B were negative, other infections could still be a factor.

4. Multi-Organ Dysfunction: As liver function declines, it can lead to a cascade of multi-organ dysfunction, where other organs (like the kidneys and lungs) also begin to fail, complicating the clinical picture.

5. Portal Hypertension: This condition can develop due to liver cirrhosis, leading to increased pressure in the portal vein and resulting in ascites and variceal bleeding.

Regarding your question about treatment options, it seems that the medical team is currently focusing on supportive care, including blood transfusions and albumin infusions to manage low blood pressure and fluid balance. While these measures are crucial for stabilizing your father's condition, they do not directly address the underlying liver dysfunction.

The possibility of liver function recovery depends on several factors:
- Extent of Liver Damage: If the liver has sustained irreversible damage, recovery may be limited. However, if there is still some functional liver tissue, there may be a chance for partial recovery, especially with appropriate medical management.

- Underlying Causes: Identifying and addressing any reversible causes of liver dysfunction (like infections or medication effects) could improve liver function.

- Liver Supportive Therapies: Treatments such as liver dialysis (MARS therapy) or other advanced supportive measures may be considered in some cases, but these depend on the overall clinical picture and the availability of such therapies.

- Liver Transplantation: If liver function does not improve and the situation becomes critical, a liver transplant may be the only definitive treatment. However, as noted, the presence of cancer can complicate eligibility for transplantation.

It is essential to maintain open communication with your father's healthcare team. They can provide the most accurate assessments based on his current condition and may consider additional interventions or referrals to specialists in liver disease or transplant hepatology if appropriate.

In summary, while your father's situation is complex and serious, there may still be options for supportive care and potential recovery of liver function. The medical team is best positioned to guide you through this process, and it is crucial to discuss all available options and any concerns you may have with them. Your father's resilience and the support of his family can play a significant role in his journey toward recovery.

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