TY - JOUR
T1 - Liver transplantation for severe Amanita phalloides mushroom poisoning
AU - Pinson, C. Wright
AU - Daya, Mohamud R.
AU - Benner, Kent G.
AU - Norton, Robert L.
AU - Deveney, Karen E.
AU - Kurkchubasche, Arlet G.
AU - Ragsdale, John W.
AU - Alexander, J. Preston
AU - Keeffe, Emmet B.
AU - Ascher, Nancy L.
AU - Roberts, John P.
AU - Lake, John R.
PY - 1990/5
Y1 - 1990/5
N2 - Amanita phalloides mushroom poisoning is an increasingly common and potentially lethal problem for which liver transplantation offers definitive therapy in selected patients. When significant liver dysfunction appears, early transfer to a liver transplant center is important to identify appropriate candidates and to begin the search for a donor organ. The clinical course of five severely poisoned patients, four of whom underwent liver transplantation, is reviewed. Indications for transplantation included primarily a markedly prolonged prothrombin time that was only partially correctable and a constellation of findings including metabolic acidosis, hypoglycemia, hypofibrinogenemia, and increased serum ammonia, following a marked elevation in serum aminotransferase levels. Unlike viral fulminant hepatic failure, grade III or IV hepatic encephalopathy, marked elevation of the serum bilirubin level, and azotemia were not indications for transplantation. Resected livers demonstrated hepatocyte viability of 0% to 30%. Manifestations of Amanita poisoning complicating preoperative and/or postoperative care included severe diarrhea, gastrointestinal hemorrhage, hypophosphatemia, bowel edema, and marrow suppression with lymphopenia, thrombocytopenia, and neutropenia. All five patients are well 1 year later. This largest experience with liver transplantation for Amanita poisoning further defines the early clinical and laboratory indications for, and the unique complicating features of, transplantation in this setting.
AB - Amanita phalloides mushroom poisoning is an increasingly common and potentially lethal problem for which liver transplantation offers definitive therapy in selected patients. When significant liver dysfunction appears, early transfer to a liver transplant center is important to identify appropriate candidates and to begin the search for a donor organ. The clinical course of five severely poisoned patients, four of whom underwent liver transplantation, is reviewed. Indications for transplantation included primarily a markedly prolonged prothrombin time that was only partially correctable and a constellation of findings including metabolic acidosis, hypoglycemia, hypofibrinogenemia, and increased serum ammonia, following a marked elevation in serum aminotransferase levels. Unlike viral fulminant hepatic failure, grade III or IV hepatic encephalopathy, marked elevation of the serum bilirubin level, and azotemia were not indications for transplantation. Resected livers demonstrated hepatocyte viability of 0% to 30%. Manifestations of Amanita poisoning complicating preoperative and/or postoperative care included severe diarrhea, gastrointestinal hemorrhage, hypophosphatemia, bowel edema, and marrow suppression with lymphopenia, thrombocytopenia, and neutropenia. All five patients are well 1 year later. This largest experience with liver transplantation for Amanita poisoning further defines the early clinical and laboratory indications for, and the unique complicating features of, transplantation in this setting.
UR - http://www.scopus.com/inward/record.url?scp=0025342883&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025342883&partnerID=8YFLogxK
U2 - 10.1016/S0002-9610(05)81254-1
DO - 10.1016/S0002-9610(05)81254-1
M3 - Article
C2 - 2334013
AN - SCOPUS:0025342883
SN - 0002-9610
VL - 159
SP - 493
EP - 499
JO - The American Journal of Surgery
JF - The American Journal of Surgery
IS - 5
ER -