title: Results of liver transplantation in patients with acute liver failure due to Amanita phalloides and paracetamol (acetaminophen) intoxication.
abstract: BACKGROUND
  Amanita phalloides and paracetamol intoxications are responsible for the majority of acute liver failures.
  
  
  OBJECTIVE
  To assess survival outcomes and to analyse risk factors affecting survival in the studied group.
  
  
  METHODS
  Of 1369 liver transplantations performed in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw before December 2013, 20 (1.46%) patients with Amanita phalloides (n = 13, 0.95%) and paracetamol (n = 7, 0.51%) intoxication were selected for this retrospective study. Overall and graft survival at 5 years were set as primary outcome measures.
  
  
  RESULTS
  Five-year overall survival after liver transplantation in the studied group was 53.57% and 53.85% in patients with paracetamol and Amanita phalloides poisoning, respectively (p = 0.816). Five-year graft survival was 26.79% for patients with paracetamol and 38.46% with Amanita phalloides intoxication (p = 0.737). Risk factors affecting patient survival were: pre-transplant bilirubin concentration (p = 0.023) and higher number of red blood cells (p = 0.013) and fresh frozen plasma (p = 0.004) transfused intraoperatively. Likewise, higher number of red blood cells (p = 0.012) and fresh frozen plasma (p = 0.007) transfused were risk factors affecting 5-year graft survival. Surprisingly, donor and recipient blood type incompatibility was neither the risk factor for 5-year overall survival (p = 0.939) nor the risk factor for 5-year graft survival (p = 0.189).
  
  
  CONCLUSIONS
  In selected intoxicated patients urgent liver transplantation is the only successful modality of treatment. Risk factors affecting survival are in correspondence with the patient's pre-transplant status (bilirubin level in serum) and intraoperative status (number of red blood cells and fresh frozen plasma transfused).
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Krasnodębski
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Grąt
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Wacław
authors.initials: W
authors.lastname: Hołówko
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Masior
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Karolina M
authors.initials: KM
authors.lastname: Wronka
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Grąt
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Stypułkowski
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Patkowski
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Krawczyk
keywords: Amanita phalloides poisoning; acute liver failure; liver transplantation; paracetamol poisoning