Indication of liver transplantation following amatoxin intoxication.
OBJECTIVE
Indication of liver transplantation in acute liver failure following amatoxin intoxication is still uncertain.


METHODS
One hundred and ninety-eight patients were studied retrospectively. The laboratory parameters alanine-aminotransferase, serum bilirubin, serum creatinine and prothrombin index were analyzed over time. Predictors of fatal outcome and survival were determined by receiver-operating-characteristic and sensitivity-specificity analysis.


RESULTS
Twenty-three patients died in the median 6.1 days (range, 2.7-13.9 days) after ingestion. Using a single parameter as predictor of fatal outcome the area under the receiver-operating-characteristic curve of prothrombin index (0.96) and serum creatinine (0.93) were both significantly greater (P<0.05) compared with serum bilirubin (0.82) and alanine-aminotransferase (0.69). Prediction of fatal outcome had an optimum, if a prothrombin index less than 25% was combined with a serum creatinine greater than 106 micromol/l from day 3 after ingestion onwards (sensitivity 100%, 95% confidence interval 87-100; specificity 98%, 95% confidence interval 94-100). The median time period between the first occurrence of this predictor in non-survivors and death was 63h (range, 3-230h).


CONCLUSIONS
A decision model of liver transplantation following amatoxin intoxication using prothrombin index in combination with serum creatinine from day 3 to 10 after ingestion enables an early and reliable assessment of outcome.
Ganzert
Martin
M
Toxicological Department, II Medizinische Klinik, Klinikum rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany. m.ganzert@Lrz.tu-muenchen.de
Felgenhauer
Norbert
N
Zilker
Thomas
T
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000546:Amanitins / Q000633:toxicity*; D001663:Bilirubin / Q000097:blood; D002648:Child; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced* / Q000401:mortality; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D009145:Mushroom Poisoning; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012189:Retrospective Studies; D016019:Survival Analysis
D000546:Amanitins; C018207:amatoxin; D000410:Alanine Transaminase; D001663:Bilirubin