Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation.
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.
Escudié
Luc
L
Hepatology Unit and INSERM U773, Hospital Beaujon, Clichy, France.
Francoz
Claire
C
Vinel
Jean-Pierre
JP
Moucari
Rami
R
Cournot
Maxime
M
Paradis
Valérie
V
Sauvanet
Alain
A
Belghiti
Jacques
J
Valla
Dominique
D
Bernuau
Jacques
J
Durand
François
F
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
D011516:Prothrombin; D001219:Aspartate Aminotransferases