AbstractBackgroundLiver injury associated with oxaliplatin (L‐OHP)‐based chemotherapy can significantly impact the treatment outcomes of patients with colorectal cancer liver metastases, especially when combined with surgery. To date, no definitive biomarker that can predict the risk of liver injury has been identified. This study aimed to investigate whether organoids can be used as tools to predict the risk of liver injury.MethodsWe examined the relationship between the clinical signs of L‐OHP‐induced liver injury and the responses of patient‐derived liver organoids in vitro. Organoids were established from noncancerous liver tissues obtained from 10 patients who underwent L‐OHP‐based chemotherapy and hepatectomy for colorectal cancer.ResultsOrganoids cultured in a galactose differentiation medium, which can activate the mitochondria of organoids, showed sensitivity to L‐OHP cytotoxicity, which was significantly related to clinical liver toxicity induced by L‐OHP treatment. Organoids from patients who presented with a high‐grade liver injury to the L‐OHP regimen showed an obvious increase in mitochondrial superoxide levels and a significant decrease in mitochondrial membrane potential with L‐OHP exposure. L‐OHP‐induced mitochondrial oxidative stress was not observed in the organoids from patients with low‐grade liver injury.ConclusionsThese results suggested that L‐OHP‐induced liver injury may be caused by mitochondrial oxidative damage. Furthermore, patient‐derived liver organoids may be used to assess susceptibility to L‐OHP‐induced liver injury in individual patients.