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Title:

Indication of liver transplantation following amatoxin intoxication.

Document type:
Journal Article
Author(s):
Ganzert, M; Felgenhauer, N; Zilker, T
Abstract:
BACKGROUND/AIMS: Indication of liver transplantation in acute liver failure following amatoxin intoxication is still uncertain. METHODS: One hundred and ninety-eight patients were studied retrospectively. The laboratory parameters alanine-aminotransferase, serum bilirubin, serum creatinine and prothrombin index were analyzed over time. Predictors of fatal outcome and survival were determined by receiver-operating-characteristic and sensitivity-specificity analysis. RESULTS: Twenty-three patients died in the median 6.1 days (range, 2.7-13.9 days) after ingestion. Using a single parameter as predictor of fatal outcome the area under the receiver-operating-characteristic curve of prothrombin index (0.96) and serum creatinine (0.93) were both significantly greater (P<0.05) compared with serum bilirubin (0.82) and alanine-aminotransferase (0.69). Prediction of fatal outcome had an optimum, if a prothrombin index less than 25% was combined with a serum creatinine greater than 106 micromol/l from day 3 after ingestion onwards (sensitivity 100%, 95% confidence interval 87-100; specificity 98%, 95% confidence interval 94-100). The median time period between the first occurrence of this predictor in non-survivors and death was 63h (range, 3-230h). CONCLUSIONS: A decision model of liver transplantation following amatoxin intoxication using prothrombin index in combination with serum creatinine from day 3 to 10 after ingestion enables an early and reliable assessment of outcome.
Journal title abbreviation:
J Hepatol
Year:
2005
Journal volume:
42
Journal issue:
2
Pages contribution:
202-9
Language:
eng
Fulltext / DOI:
doi:10.1016/j.jhep.2004.10.023
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/15664245
Print-ISSN:
0168-8278
TUM Institution:
2. Medizinische Klinik Toxikologische Abteilung (alt) (Prof. Zilker)
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