title: Experience of Treatments of Amanita phalloides-Induced Fulminant Liver Failure with Molecular Adsorbent Recirculating System and Therapeutic Plasma Exchange.
abstract: Ingestion of the mushroom containing Amanita phalloides can induce fulminant liver failure and death. There are no specific antidotes. Blood purifications, such as molecular adsorbent recirculating system (MARS) and therapeutic plasma exchange (TPE), are potential therapies. However, the extent to which these technologies avert the deleterious effects of amatoxins remains controversial; the optimal intensity, duration, and initiation criteria have not been determined yet. This study aimed to retrospectively observe the effects of MARS and TPE on nine patients with A. phalloides-induced fulminant liver failure. The survival rate for the nine patients was 66.7%. Both TPE and MARS might remove toxins and improve liver functions. However, a single session of TPE produced immediately greater improvements in alanine aminotransferase (-60% vs. -16.3%), aspartate aminotransferase (-47.6% vs. -15.4%), and total bilirubin (-37.3% vs. -17.1%) (compared with the values of pretreatment, all p < 0.05) than MARS compared with MARS. Early intervention may be more effective than delayed therapy. Additionally, the presence of severe liver failure and renal failure indicated worse outcome. Although these findings are promising, additional case-controlled, randomized studies are required to confirm our results.
authors.affiliation: From the *Department of Critical Care Medicine, Provincial Hospital Affiliated Shandong University, Jinan, China; †Jinan Infectious Disease Hospital, Shandong University, Jinan, China; ‡Center of Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and §Juxian Center for Disease Prevention and Control, Shandong, China.
authors.forename: Jicheng
authors.initials: J
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Peng
authors.forename: Donald
authors.initials: D
authors.lastname: Maberry
authors.forename: Xueqiang
authors.initials: X
authors.lastname: Feng
authors.forename: Pengfei
authors.initials: P
authors.lastname: Bian
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Ma
authors.forename: Chunting
authors.initials: C
authors.lastname: Wang
authors.forename: Chengyong
authors.initials: C
authors.lastname: Qin
mesh_terms: D000545:Amanita / Q000737:chemistry*; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000150:complications / Q000628:therapy*; D010951:Plasma Exchange / Q000379:methods*; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000379:methods*; D055815:Young Adult