THE PLACE OF LIVER-TRANSPLANTATION IN THE TREATMENT OF ACUTE LIVER-FAILURE CAUSED BY AMANITA-PHALLOIDES POISONING

Objective;: To formulate the indications for liver transplantation in the treatment of acute liver failure after Amanita phalloides poisonin g and to determine the results of this treatment. Patients and methods : In 1994 twelve patients with acute Amanita phalloides poisoning were treated in the intensive care unit of our hospital's toxicology depar tment. Three of them developed irreversible signs of poisoning and wer e given orthotopic liver transplants. The findings and course of this group of patients were analysed retrospectively and prognostic criteri a defined on the basis of this personal experience and published data. Results: Amanita phalloides poisoning differs from other causes of ac ute liver failure in several respects. The following criteria make it possible reliably to distinguish a lethal from a non-lethal course: a Quick value < 20% over the course of several days, serum creatinine co ncentration > 1.4 mg%, even after correcting water and electrolyte abn ormalities, serum bilirubin > 4.6 mg%, and progressive encephalopathy indicate a lethal course. Two of three patients survived severe poison ing by being given a liver transplant. Renal failure, pancreatitis and bone marrow suppression, in addition to liver failure, were signs rel evant to treatment decisions. Conclusion: Liver transplantation is the procedure of choice in the treatment of acute Amanita phalloides pois oning, if the criteria for a probably lethal course under conservative treatment have been met. This should be taken into account when poiso ned patients are to be transferred to a centre for treatment.