Liver Transplantation for Acute Liver Failure due to Mushroom Poisoning
Main Article Content
Abstract
Background/Aims: Liver transplantation is a life-saving approach in some cases of mushroom poisoning, which is one of the important causes of acute liver failure. However, debate continues regarding the timing of liver transplantation. The aim of this study is to retrospectively evaluate the results of patients who underwent liver transplantation due to mushroom poisoning.
Materials and Methods: In this descriptive and observational study, the demographic and clinical data of 26 patients who presented to emergency units due to clinical features of acute hepatic failure secondary to mushroom poisoning between October 2008 and November 2023 and who underwent emergent liver transplantation were retrospectively reviewed.
Results: A total of 26 patients with a median (IQR) age of 39 (36) years were included in this study. The patients were divided into two groups: alive (n = 18) and dead (n = 8). No statistically significant differences were found between groups in terms of age, BMI, blood groups, hepatic encephalopathy grade, biochemical analysis obtained on the first days of hospital admission (AST, ALT, creatinine, ammonia, PTT, INR, albumin, platelets, HGB), ICU stay, cold ischemia time (CIT) and warm ischemia time (WIT), total bilirubin (P = .052), and time from poisoning to admission (P = .051). On the other hand, there were statistically significant differences between the alive and dead groups in terms of MELD score (P = .016; 23 vs. 34), re-transplantation (P = .022; 0% vs. 37.5%), hospital stay (P = .004; 24 vs. 6 days), and follow up (P < .001; 3423 vs. 5 days).
Conclusions: This study showed that mortality was higher in patients with high MELD scores and patients who underwent re-transplantation. However, this study needs to be supported by multicenter prospective studies.
Cite this article as: Canbaz H, Bestemir A, Akbulut S, Yilmaz S, Yavuz Y. Liver transplantation for acute liver failure due to mushroom poisoning. Turk J Gastroenterol. 2025;36(2):107-113.
Article Details
References
1. Bernal W, Wendon J. Acute liver failure. N Engl J Med. 2013;369(26):2525-2534. [CrossRef]
2. Beaumier M, Rioult JP, Georges M, Brocheriou I, Lobbedez T, Lanot A. Mushroom poisoning presenting with acute kidney injury and elevated transaminases. Kidney Int Rep. 2019;4(6):877-881. [CrossRef]
3. Çelik F, Ünal NG, Şenkaya A, et al. Outcomes of patients with acute hepatotoxicity caused by mushroom-induced poisoning. Turk J Gastroenterol. 2021;32(8):678-684. [CrossRef]
4. Janatolmakan M, Jalilian M, Rezaeian S, Abdi A, Khatony A. Mortality rate and liver transplant in patients with mushroom poisoning: a systematic review & meta-analysis. Heliyon. 2023;9(1):e12759. [CrossRef]
5. Gün E, Durak A, Botan E, et al. Extracorporeal therapies in children with acute liver failure: a single-center experience. Turk J Gastroenterol. 2023;34(1):73-79. [CrossRef]
6. European Association for the Study of the Liver. Wendon J, Cordoba J, Dhawan A, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66(5):1047-1081. [CrossRef]
7. Mishra A, Rustgi V. Prognostic models in acute liver failure. Clin Liver Dis. 2018;22(2):375-388. [CrossRef]
8. Pathikonda M, Munoz SJ. Acute liver failure. Ann Hepatol. 2010;9(1):7-14. [CrossRef]
9. Ferreira R, Romãozinho JM, Amaro P, Ferreira M, Sofia C. Assessment of emergency liver transplantation criteria in acute liver failure due to Amanita phalloides. Eur J Gastroenterol Hepatol. 2011;23(12):1226-1232. [CrossRef]
10. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97(2):439-445. [CrossRef]
11. Zhang XM, Fan H, Wu Q, Zhang XX, Lang R, He Q. In-hospital mortality of liver transplantation and risk factors: a single-center experience. Ann Transl Med. 2021;9(5):369. [CrossRef]
12. Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2015 annual data report: liver. Am J Transplant. 2017;17(suppl 1):174-251. [CrossRef]
13. Adam R, Karam V, Cailliez V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) −50-year evolution of liver transplantation. Transpl Int. 2018;31(12):1293-1317.
14. Trieu JA, Bilal M, Hmoud B. Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database. Ann Gastroenterol. 2018;31(1):84-89. [CrossRef]
15. Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the United States. Mycologia. 2018;110(4):637-641. [CrossRef]
16. Germani G, Battistella S, Ulinici D, et al. Drug induced liver injury: from pathogenesis to liver transplantation. Minerva Gastroenterol (Torino). 2021;67(1):50-64. [CrossRef]
17. Weber S, Woischke C, Denk G, Gerbes AL. Novel predictors for liver transplantation or death in drug-induced acute liver failure. Eur J Gastroenterol Hepatol. 2022;34(4):422-425. [CrossRef]
18. Kumar R, Anand U, Priyadarshi RN. Liver transplantation in acute liver failure: dilemmas and challenges. World J Transplant. 2021;11(6):187-202. [CrossRef]
19. Ertugrul G, Yanaral T. Liver transplantations in acute failure; a single center experiences. Online Türk Sağlık Bilimleri Derg. 2019;4(4):519-525. [CrossRef]
20. Canbaz H, Bestemir A, Surel A, et al. Türkiye’de COVID-19 ile enfekte olan solid organ nakilli hastaların acil servis ve hastane başvurularının incelenmesi. Tıbbi Sosyal Hizmet Dergisi. 2021:67-81.
21. Ferenci P. Hepatic encephalopathy. Gastroenterol Rep (Oxf). 2017;5(2):138-147. [CrossRef]
22. O’Grady J. Liver transplantation for acute liver failure. Best Pract Res Clin Gastroenterol. 2012;26(1):27-33. [CrossRef]
23. Goldaracena N, Spetzler VN, Marquez M, et al. Live donor liver transplantation: a valid alternative for critically ill patients suffering from acute liver failure. Am J Transplant. 2015;15(6):1591-1597. [CrossRef]
24. Siddiqui MS, Stravitz RT. Intensive care unit management of patients with liver failure. Clin Liver Dis. 2014;18(4):957-978. [CrossRef]
25. Thiel K, Schenk M, Sipos B, et al. Acute liver failure after amanitin poisoning: a porcine model to detect prognostic markers for liver regeneration. Hepatol Int. 2014;8(1):128-136. [CrossRef]
26. Badsar A, Rahber TM, Amir MA, Rouhi RM, Chatrnour G, Khajeh JS. Mushroom poisoning in the southwest region of the Caspian Sea, Iran: a retrospective study. Iran J Toxicol. 2013;7:798-803.
27. Shingina A, Ziogas IA, Vutien P, et al. Adult-to-adult living donor liver transplantation in acute liver failure. Transplant Rev (Orlando). 2022;36(2):100691. [CrossRef]
28. Pamecha V, Vagadiya A, Sinha PK, et al. Living donor liver transplantation for acute liver failure: donor safety and recipient outcome. Liver Transpl. 2019;25(9):1408-1421. [CrossRef]