eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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2/2016
vol. 11
 
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abstract:
Original paper

Results of liver transplantation in patients with acute liver failure due to Amanita phalloides and paracetamol (acetaminophen) intoxication

Maciej Krasnodębski
,
Michał Grąt
,
Wacław Hołówko
,
Łukasz Masior
,
Karolina M. Wronka
,
Karolina Grąt
,
Jan Stypułkowski
,
Waldemar Patkowski
,
Marek Krawczyk

Gastroenterology Rev 2016; 11 (2): 90–95
DOI: https://doi.org/10.5114/pg.2015.52031
Online publish date: 2015/06/22
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Introduction: Amanita phalloides and paracetamol intoxications are responsible for the majority of acute liver failures.

Aim: To assess survival outcomes and to analyse risk factors affecting survival in the studied group.

Material and methods: Of 1369 liver transplantations performed in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw before December 2013, 20 (1.46%) patients with Amanita phalloides (n = 13, 0.95%) and paracetamol (n = 7, 0.51%) intoxication were selected for this retrospective study. Overall and graft survival at 5 years were set as primary outcome measures.

Results: Five-year overall survival after liver transplantation in the studied group was 53.57% and 53.85% in patients with paracetamol and Amanita phalloides poisoning, respectively (p = 0.816). Five-year graft survival was 26.79% for patients with paracetamol and 38.46% with Amanita phalloides intoxication (p = 0.737). Risk factors affecting patient survival were: pre-transplant bilirubin concentration (p = 0.023) and higher number of red blood cells (p = 0.013) and fresh frozen plasma (p = 0.004) transfused intraoperatively. Likewise, higher number of red blood cells (p = 0.012) and fresh frozen plasma (p = 0.007) transfused were risk factors affecting 5-year graft survival. Surprisingly, donor and recipient blood type incompatibility was neither the risk factor for 5-year overall survival (p = 0.939) nor the risk factor for 5-year graft survival (p = 0.189).

Conclusions: In selected intoxicated patients urgent liver transplantation is the only successful modality of treatment. Risk factors affecting survival are in correspondence with the patient’s pre-transplant status (bilirubin level in serum) and intraoperative status (number of red blood cells and fresh frozen plasma transfused).
keywords:

acute liver failure, Amanita phalloides poisoning, paracetamol poisoning, liver transplantation
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