Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation.

Abstract

BACKGROUND/AIMS:

Amanita phalloides poisoning is an uncommon cause of acute liver failure with an especially rapid course. The aim of this study was to re-assess transplantation criteria in patients with mushroom poisoning.

METHODS:

Twenty-seven patients admitted for Amanita phalloides poisoning were studied. Previously reported transplantation criteria, including the recent Ganzert's criteria, were tested retrospectively.

RESULTS:

The rate of fatal intoxication (death and/or transplantation) was 8/27 (30%). An interval between ingestion and diarrhea <8h was a very early predictor of a fatal outcome (accuracy of 78%). Later on, non-paracetamol and paracetamol King's College criteria were superior to Clichy's and Ganzert's criteria (accuracy of 100% compared to 85% and 85%, respectively). Encephalopathy and renal insufficiency were not constant in the fatal intoxication group. Prothrombin index below 10% 4 days or more after ingestion had a 100% accuracy for predicting a fatal outcome.

CONCLUSIONS:

Liver transplantation should be strongly considered in patients with an interval between ingestion and diarrhea <8h. Encephalopathy should not be an absolute prerequisite for deciding transplantation. From day 4 after ingestion, prothrombin index lower than 10% ( approximately INR of 6) alone is a reliable tool for deciding emergency transplantation.

• Authors: Luc Escudié, Claire Francoz, Jean-Pierre Vinel, Rami Moucari, Maxime Cournot, Valérie Paradis, Alain Sauvanet, Jacques Belghiti, Dominique Valla, Jacques Bernuau, François Durand
• Journal: Journal of hepatology (J Hepatol) Vol. 46 Issue 3 Pg. 466-73 (Mar 2007) ISSN: 0168-8278 [Print] Netherlands
• PMID: 17188393 (Publication Type: Journal Article)

Chemical References

• Prothrombin
• Aspartate Aminotransferases

Topics

• Adult
• Aged
• Amanita
• Aspartate Aminotransferases (blood)
• Emergency Treatment (methods)
• Female
• Hepatic Encephalopathy (diagnosis, etiology)
• Humans
• Liver Failure, Acute (blood, etiology, surgery)
• Liver Transplantation (methods)
• Male
• Middle Aged
• Mushroom Poisoning (complications)
• Predictive Value of Tests
• Prognosis
• Prothrombin (metabolism)
• Renal Insufficiency (diagnosis, etiology)
• Retrospective Studies