@article{254162042cdd4a0285e0c15eee181500,
title = "Acute liver injury and acute liver failure from mushroom poisoning in North America",
abstract = "Background & Aims: Published 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. Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Results: Of 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). Conclusion: Patients 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.",
keywords = "Amanita phalloides, acute liver failure, acute liver injury, fulminant hepatic failure, liver transplantation, mushroom toxicity",
author = "{the United States Acute Liver Failure Study Group} and Karvellas, {Constantine J.} and Holly Tillman and Leung, {Alexander A.} and Lee, {William M.} and Schilsky, {Michael L.} and Bilal Hameed and Stravitz, {R. Todd} and McGuire, {Brendan M.} and Fix, {Oren K.} and Lee, {W. M.} and Larson, {Anne M.} and Iris Liou and Oren Fix and Michael Schilsky and Timothy McCashland and {Eileen Hay}, J. and Natalie Murray and A. Obaid and S. Shaikh and Andres Blei and Daniel Ganger and Atif Zaman and Han, {Steven H.B.} and Robert Fontana and Brendan McGuire and Chung, {Raymond T.} and Alastair Smith and Robert Brown and Jeffrey Crippin and Edwin Harrison and Adrian Reuben and Santiago Munoz and Rajender Reddy and Lorenzo Rossaro and Raj Satyanarayana and Tarek Hassanein and Jodi Olson and Ram Subramanian and James Hanje and Grace Samuel and Ezmina Lalani and Carla Pezzia and Corron Sanders and Nahid Attar and Hynan, {Linda S.} and Valerie Durkalski and Wenle Zhao and Jaime Speiser and Catherine Dillon and Holly Battenhouse",
note = "Funding Information: Members and institutions participating in the Acute Liver Failure Study Group 1998–2015 are as follows: W.M. Lee, M.D. (Principal Investigator); Anne M. Larson, M.D., Iris Liou, M.D., University of Washington, Seattle, WA; Oren Fix, M.D., Swedish Medical Center, Seattle, WA; Michael Schilsky, M.D., Yale University, New Haven, CT; Timothy McCashland, M.D., University of Nebraska, Omaha, NE; J. Eileen Hay, M.B.B.S., Mayo Clinic, Rochester, MN; Natalie Murray, M.D., Baylor University Medical Center, Dallas, TX; A. Obaid, S. Shaikh, M.D., University of Pittsburgh, Pittsburgh, PA; Andres Blei, M.D., Northwestern University, Chicago, IL (deceased), Daniel Ganger, M.D., Northwestern University, Chicago, IL; Atif Zaman, M.D., University of Oregon, Portland, OR; Steven H.B. Han, M.D., University of California, Los Angeles, CA; Robert Fontana, M.D., University of Michigan, Ann Arbor, MI; Brendan McGuire, M.D., University of Alabama, Birmingham, AL; Raymond T. Chung, M.D., Massachusetts General Hospital, Boston, MA; Alastair Smith, M.B., Ch.B., Duke University Medical Center, Durham, NC; Robert Brown, M.D., Cornell/Columbia University, New York, NY; Jeffrey Crippin, M.D., Washington University, St Louis, MO; Edwin Harrison, Mayo Clinic, Scottsdale, AZ; Adrian Reuben, M.B.B.S., Medical University of South Carolina, Charleston, SC; Santiago Munoz, M.D., Albert Einstein Medical Center, Philadelphia, PA; Rajender Reddy, M.D., University of Pennsylvania, Philadelphia, PA; R. Todd Stravitz, M.D., Virginia Commonwealth University, Richmond, VA; Lorenzo Rossaro, M.D., University of California Davis, Sacramento, CA; Raj Satyanarayana, M.D., Mayo Clinic, Jacksonville, FL; and Tarek Hassanein, M.D., University of California, San Diego, CA; Constantine J. Karvellas MD, University of Alberta, Edmonton, AB; Jodi Olson MD, University of Kansas, Kansas City, KA; Ram Subramanian MD, Emory, Atlanta, GA; James Hanje MD, Ohio State University, Columbus, OH. The University of Texas Southwestern Administrative Group included Grace Samuel, Ezmina Lalani, Carla Pezzia, and Corron Sanders, Ph.D., Nahid Attar, Linda S. Hynan, Ph.D., and the Medical University of South Carolina Data Coordination Unit included Valerie Durkalski, Ph.D., Wenle Zhao, Ph.D., Jaime Speiser, Catherine Dillon, Holly Battenhouse and Michelle Gottfried. Financial support: This study was sponsored by NIH grant U-01 58369 (from NIDDK). Conflict of interest: All authors (CJK, HT, AAL, WML, MLS, BH, RTS, BMM, OKF) have no personal or funding conflicts of interest. Format: This paper followed the STROBE guideline for reporting cohort studies (BMJ 2007): See File S1. Publisher Copyright: {\textcopyright} 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2016",
month = jul,
day = "1",
doi = "10.1111/liv.13080",
language = "English",
volume = "36",
pages = "1043--1050",
journal = "Liver International",
issn = "1478-3223",
number = "7",
}