Amanita phalloides poisoning is an uncommon cause of acute liver failure with an especially rapid course.
Dr François Durand and colleagues from France re-assessed transplantation criteria in patients with mushroom poisoning.
The investigative team studied 27 patients admitted for Amanita phalloides poisoning.
Previously reported transplantation criteria, including the recent Ganzert's criteria, were tested retrospectively.
|Prothrombin index less than 10% had a 100% accuracy|
|Journal of Hepatology|
The investigators found that the rate of fatal intoxication was 30%.
An interval between ingestion and diarrhea less than 8 hours was a very early predictor of a fatal outcome.
Later on, non-paracetamol and paracetamol King's College criteria were superior to Clichy's and Ganzert's criteria.
The team noted that encephalopathy and renal insufficiency were not constant in the fatal intoxication group.
The investigators observed that prothrombin index below 10% 4 days or more after ingestion had a 100% accuracy for predicting a fatal outcome.
Dr Durand's team commented, “Liver transplantation should be strongly considered in patients with an interval between ingestion and diarrhea less than 8 hours.”
“Encephalopathy should not be an absolute prerequisite for deciding transplantation.”
“From day 4 after ingestion, prothrombin index lower than 10% alone is a reliable tool for deciding emergency transplantation.”