title: Assessment of emergency liver transplantation criteria in acute liver failure due to Amanita phalloides.
abstract: OBJECTIVE
  The emergency liver transplantation criteria for acute liver failure (ALF) due to Amanita phalloides (A. phalloides) intoxication are not consensual. The aims of this study were to evaluate the clinical outcomes, and to assess the accuracy of the current and specific criteria for emergency liver transplantation in predicting fatal outcome in ALF induced by A. phalloides.
  
  
  METHODS
  Ten patients admitted with ALF induced by A. phalloides in a Gastroenterology Intensive Care Unit were studied. Indications for liver transplant were based on Clichy and/or King's College criteria. Specific criteria of Ganzert and Escudié were tested retrospectively.
  
  
  RESULTS
  A. phalloides intoxication represented 11.6% of all admissions for ALF. Patients were admitted at a mean time of 60 ± 20.4 h after ingestion. Eight patients met the Clichy and/or King's College criteria for emergency liver transplantation, seven of these patients were listed for transplant and only six patients were transplanted. Four (40%) patients died in a mean time of 4.8 ± 0.74 days after ingestion. When applied retrospectively, Escudié's criteria showed 100% of accuracy for predicting fatal outcome, whereas, King's College, Clichy's and Ganzert's criteria had an accuracy of 90, 80 and 70%, respectively. A prothrombin index of less than 10% at day 3 after ingestion showed a positive predictive value of 100% and a negative predictive value of 60%.
  
  
  CONCLUSIONS
  Escudié's criteria show the best accuracy for emergency liver transplant in ALF induced by A. phalloides. The assessment of these criteria at day 3 after ingestion shows a maximum positive predictive value, although with a decline in its negative predictive value.
authors.affiliation: Gastroenterology Department of Hospital Center of Coimbra, Portugal. rosa.l.ferreira@gmail.com
authors.forename: Rosa
authors.initials: R
authors.lastname: Ferreira
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Romãozinho
authors.forename: Pedro
authors.initials: P
authors.lastname: Amaro
authors.forename: Manuela
authors.initials: M
authors.lastname: Ferreira
authors.forename: Carlos
authors.initials: C
authors.lastname: Sofia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000545:Amanita; D004630:Emergencies; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000150:complications*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome