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CION Cancer Clinics
Radioembolisation-induced liver disease (REILD) after Y-90 | CION Cancer Clinics
Radioembolisation-induced liver disease, or REILD, is damage to the healthy liver caused by Y-90 radiation. It is uncommon, usually appears one to two months after treatment, and is more likely in a liver already weakened by cirrhosis. This page explains who is at risk, the signs to watch for, how doctors tell it apart from other problems, and which symptoms mean going to hospital today. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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The short answer
What is radioembolisation-induced liver disease?
Radioembolisation-induced liver disease, or REILD, is damage to the healthy part of the liver caused by the radiation from Y-90 treatment. It is uncommon, it usually appears one to two months after treatment, and it is far more likely in a liver that was already weak.
Y-90, also called TARE, places tiny radioactive beads into the arteries that feed a liver tumour. Most of the radiation lands in the tumour. Some always reaches the normal liver around it. A healthy liver copes with that well. A liver scarred by cirrhosis, or one already strained by earlier treatment, may not. When it does not cope, the small veins inside the liver become blocked and inflamed, and the liver struggles to do its work.
Why it gets its own name
Doctors separate REILD from the cancer growing, from a blocked bile duct, and from hepatitis flaring up, because each is handled differently. The signs can look alike: yellow eyes, a swelling abdomen, tiredness. Only tests can tell them apart.
Primary or secondary cancer
REILD can follow Y-90 for primary liver cancer or for cancer that has spread to the liver. People who have had chemotherapy for bowel cancer before Y-90 may carry extra liver strain, which the team takes into account. For the full range of what to expect after treatment, see side effects of Y-90.
Who is more at risk
Who is more likely to get REILD after Y-90?
The team weighs these before treatment, and they are the main reason Y-90 is not offered to everyone.
A liver already weakened
Cirrhosis, especially Child-Pugh B or worse, leaves less healthy liver in reserve. Child-Pugh is a score built from blood tests and symptoms that shows how well the liver is working. The Child-Pugh page explains the grades.
A raised bilirubin before treatment
Bilirubin is the yellow pigment a healthy liver clears. If it is already high, the liver has little room to absorb more strain.
Treating a large part of the liver
Treating both sides at once, or the whole liver in one session, exposes more healthy tissue to radiation.
How teams reduce this
- Treating one segment or one lobe at a time
- Careful radiation dose planning for each patient
- Waiting for blood tests to settle between sessions
Earlier treatment to the liver
Previous chemotherapy, external radiation, TACE or surgery can each leave the remaining liver less able to recover. A small liver left after an operation is also more vulnerable.
Not sure whether this applies to you?
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Signs that mean hospital today
Go to hospital the same day, and say you have had Y-90 to the liver, if the person becomes confused or unusually drowsy, vomits blood or passes black stools, has a fever or pain with a swollen abdomen, or turns yellow quickly. These can mean the liver is failing or that fluid in the abdomen is infected. Do not wait for the next clinic visit. Slowly worsening tiredness or ankle swelling needs a call to your team this week.
If it is suspected
How do doctors check for REILD and treat it?
Blood tests first
Bilirubin, albumin and the clotting test called INR are compared with your results from before Y-90. A steady climb in bilirubin is often the first clue, sometimes before you feel any different.
A scan to rule out other causes
An ultrasound or CT checks for a blocked bile duct, a clot in a vein, fluid in the abdomen or new tumour growth. CION arranges these scans through diagnostic partners.
A review by the team
The tumour board, often with a hepatologist, reads the tests together. REILD is usually diagnosed by putting the timing, the blood tests and the scan together, once other causes are excluded.
Supportive treatment
There is no single proven treatment. Care focuses on helping the liver recover: water tablets for fluid, medicines for confusion, and sometimes steroids or a bile acid tablet. The evidence for these is thin.
Pausing further cancer treatment
Further liver-directed treatment usually waits until the liver settles. Some people recover fully. Others are left with weaker liver function, which changes later options.
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Side by side
Is it REILD, or something else after Y-90?
Often REILD
Often something else
Appears one to two months after treatment
Feeling unwell in the first few days is usually the expected reaction
Bilirubin climbs, fluid builds, no blockage on the scan
A blocked bile duct shows up on the scan and is treated differently
Tumour on the scan is stable or shrinking
Yellowing with new growth on the scan points to the cancer itself
Hepatitis B tests unchanged
A hepatitis B flare shows in the virus count and needs antivirals
Commonly believed
What families worry about, and what is actually true
"Yellow eyes after Y-90 means the cancer has spread."
Not necessarily. Yellowing can come from REILD, a blocked bile duct or a hepatitis flare as well as from the cancer. Tests are needed before anyone can say which.
"This is the same as radiation damage from external radiotherapy."
They are related but not the same. Liver damage from external beams has its own page on radiation-induced liver disease. REILD comes from beads placed inside the liver.
"We should cut protein so the liver can rest."
A struggling liver still needs enough protein and enough food. Cutting it without advice can cause muscle loss and weakness. Ask the team or a dietitian before changing the diet.
"A liver tonic will repair the damage."
Herbal tonics and detox mixtures can add their own injury to a liver that is already strained. Tell the team about anything you take. Nobody will judge you for asking.
Being straight with you
What this page cannot tell you
It cannot tell you whether a change in your blood tests or your symptoms is REILD. That needs your results from before Y-90, a scan and a team who knows your liver. Nor can it tell you how likely REILD is for you personally. Your team can explain how your own liver function and the planned treatment shape that risk.
It cannot predict recovery
Some people recover fully and go on to other treatment. Some are left with a weaker liver. Nobody can say in advance which, and this page gives no outlook for any individual.
Who this does not apply to
If you have not had Y-90, REILD does not apply to you. If you are deciding about Y-90, the questions belong to who is suitable for Y-90. If you had external radiation or SBRT instead, the related condition is covered separately. CION's tumour board reviews your scans and blood tests, and coordinates Y-90 and hepatology care through partner hospitals.
If you are unsure whether a new symptom matters, call the helpline and describe it. Someone will tell you whether it can wait.Questions we are asked
Common questions about REILD
How common is REILD?
It is uncommon, and serious cases are rarer still. How often it happens varies between studies, because each uses different definitions and different patients. What is consistent is that it is more likely in people with cirrhosis, a raised bilirubin, or a large part of the liver treated at once.
When does REILD usually start?
It usually shows up one to two months after Y-90, rather than in the first few days. That is why blood tests continue for several weeks after treatment even when you feel well. Feeling unwell in the first days after Y-90 is more often the expected reaction than REILD.
What are the first signs?
Often a rising bilirubin on a blood test, before any symptom. Later signs include yellow eyes or skin, a swelling abdomen, ankle swelling, and tiredness that gets worse instead of better. Confusion, vomiting blood or fever with a swollen abdomen mean going to hospital the same day.
Can REILD be reversed?
In many people the liver recovers over time with supportive care. In some, liver function stays weaker than before. There is no single proven treatment, and the evidence for steroids and other medicines is limited. Your team will explain what they recommend and why.
Can REILD be prevented?
The risk can be lowered. Teams choose patients carefully, plan the radiation dose for each person, and often treat one part of the liver at a time. Checking liver tests before each session helps. None of this removes the risk completely.
Does REILD mean I can no longer have cancer treatment?
Not necessarily. Further treatment usually waits until the liver settles. Once it does, the tumour board looks at what options remain, which may include tablets or immunotherapy given at a CION centre. A weaker liver may narrow the choices, and the team will be honest about that.
Is REILD related to hepatitis B?
They are different, but hepatitis B can flare after liver treatment and look similar. People with hepatitis B usually stay on antiviral tablets, which keep the virus controlled. Antiviral decisions belong to a hepatologist or physician. Do not stop them without advice.
Who should I call if my bilirubin is rising?
Call the team who arranged your Y-90, or the CION helpline, and share the report. Someone will tell you whether it needs review this week. If the person is confused, drowsy or vomiting blood, do not call first. Go straight to the nearest hospital.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- RadiologyInfo.org (RSNA/ACR) — Radioembolization (Y90)
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
- American Cancer Society — Embolization Therapy for Liver Cancer
- NIDDK — Cirrhosis - NIDDK
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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Worried about liver tests after Y-90?
Share your reports from before and after treatment. We will help you understand what the team needs to check next. One helpline serves every CION centre.