Liver Damage in Nurses Handling Cytostatic Agents

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Abstract
Three consecutive head nurses developed liver injury after years of handling cytostatic drugs [used in cancer therapy]. They had neurological symptoms associated with elevated serum alanine aminotransferase (ALAT) and alkaline phosphatase (ALP) levels. Liver histology showed portal hepatitis with piecemeal necrosis in one of them; the others had hepatic fibrosis and fat accumulation. The subjects'' livers were metabolically active as reflected by adaptive and toxic changes in cellular ultrastructure. After withdrawal of the drugs, serum ALAT and ALP values fluctuated between normal and 2-3 times elevated. Follow-up biopsies demonstrated an increase in collagen fibers and a decrease in microsomal enzyme activity, as reflected by arylhydrocarbon hydroxylase activity in vitro. Apparently, handling of cytostatic drugs may insidiously damage the liver, which, with time, seems to lead to irreversible fibrosis.