title: Effectiveness of Fractionated Plasma Separation and Absorption as a Treatment for Amanita Phalloides Poisoning.
abstract: BACKGROUND Fractionated plasma separation and absorption (FPSA) is an extracorporeal liver support method that detoxifies accumulated toxins. There are limited data of its use in the treatment of Amanita phalloides intoxication. The objective of this study was to investigate whether FPSA before liver transplantation improves patients' short-term post liver transplantation survival in Amanita phalloides poisoning. MATERIAL AND METHODS The study population consisted of ten patients who had liver transplantation (LT) due to acute liver failure (ALF) caused by Amanita phalloides poisoning. Six patients were treated with FPSA before liver transplantation. All the patients who were started on FPSA were also placed on the liver transplantation list according to emergent liver transplantation criteria. RESULTS Patients treated with FPSA were in a more severe clinical condition presenting in higher mean MELD, total bilirubin, INR and ammonia along with more frequent hypoglycemia and hepatic encephalopathy grade 3/4. FPSA group had longer mean waiting time on the recipient list (3.5 vs. 1.25 days) but inferior thirty-day survival rate (16.5% vs. 100%). CONCLUSIONS When conservative medical modalities are ineffective, the only treatment for Amanita phalloides poisoning is a liver transplant. Although FPSA treated patients had inferior post-LT survival, FPSA was found to prolong the pre surgical waiting time for critically ill patients, consequently giving a chance of life-saving procedure.
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Stankiewicz
authors.affiliation: Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Lewandowski
authors.affiliation: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kotulski
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
mesh_terms: D000328:Adult; D000368:Aged; D000545:Amanita; D000546:Amanitins / Q000097:blood / Q000302:isolation & purification; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000097:blood / Q000150:complications* / Q000628:therapy*; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000379:methods*; D013997:Time Factors; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D000546:Amanitins; C018358:phallotoxin; C018207:amatoxin