title: Successful outcome of severe Amanita phalloides poisoning in children.
abstract: Amanita phalloides intoxication can lead to FHF with high mortality, especially in children. There is still ongoing discussion about the optimal treatment and decision criteria for emergency liver transplantation (LTx). Here, we summarize our experience with outcomes in five children. Five children with severe A. phalloides intoxication were treated at our tertiary center from 1995 to 2010 and studied retrospectively with respect to clinical and laboratory aspects that might help to decide between LTx or conservative therapy only. The findings are discussed with regard to recommended treatment and transplantation criteria for adults. All patients survived, of whom two of five received emergency LTx. Three patients survived with conservative treatment consisting of intravenous silibinin, NAC, detoxification measures, and intensive care. Indications for LTx in two children were progressive brain edema and cardiovascular failure. Children with FHF due to A. phalloides intoxication should be considered early for emergency LTx but should be monitored closely for the necessity of definite LTx. Early detoxification with active charcoal as well as silibinin and NAC seems to improve the outcome. Late recovery of liver function after day 4 post-ingestion is possible.
authors.affiliation: Department of Pediatric Hepatology and Liver Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany. a.richter@uke.de
authors.forename: Enke
authors.initials: E
authors.lastname: Grabhorn
authors.forename: Dirk
authors.initials: D
authors.lastname: Nielsen
authors.forename: Georg
authors.initials: G
authors.lastname: Hillebrand
authors.forename: Florian
authors.initials: F
authors.lastname: Brinkert
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000545:Amanita; D000975:Antioxidants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D009145:Mushroom Poisoning / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D000077385:Silybin; D012838:Silymarin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D012838:Silymarin; D000077385:Silybin; D000111:Acetylcysteine
keywords: acute liver failure; mushroom poisoning; outcome; pediatric liver transplantation; prognostic scores