title: Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation.
abstract: OBJECTIVE
  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.affiliation: Hepatology Unit and INSERM U773, Hospital Beaujon, Clichy, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Escudié
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vinel
authors.forename: Rami
authors.initials: R
authors.lastname: Moucari
authors.forename: Maxime
authors.initials: M
authors.lastname: Cournot
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Dominique
authors.initials: D
authors.lastname: Valla
authors.forename: Jacques
authors.initials: J
authors.lastname: Bernuau
authors.forename: François
authors.initials: F
authors.lastname: Durand
mesh_terms: D000328:Adult; D000368:Aged; D000545:Amanita; D001219:Aspartate Aminotransferases / Q000097:blood; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000209:etiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D011516:Prothrombin / Q000378:metabolism; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D011516:Prothrombin; D001219:Aspartate Aminotransferases