• Constantine J Karvellas, Holly Tillman, Alexander A Leung, William M Lee, Michael L Schilsky, Bilal Hameed, Stravitz R Todd RT Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA., Brendan M McGuire, Oren K Fix, and United States Acute Liver Failure Study Group.
• Divisions of Hepatology and Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
• Liver Int. 2016 Jul 1; 36 (7): 1043-50.

Background & AimsPublished estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies.MethodsCohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014.ResultsOf the 2224 subjects in the registry, 18 (0.8%) had A-ALF (n = 13) or A-ALI (n = 5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mm, P = 0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 μm) and MELD scores (28 vs. 24) were similar (P > 0.2 for all). Of the 13 patients with ALF, six survived without LT (46%), five survived with LT (39%) and two died without LT (15%). Of the five patients with ALI, four (80%) recovered and one (20%) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88% vs. SS 80%); whereas, silibinin (25% vs. 50%), penicillin (50% vs. 25%) and nasobiliary drainage (0 vs. 10%) were used less frequently (P > 0.15 for all therapies).ConclusionPatients with mushroom poisoning with ALI have favourable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT.© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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