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J Hepatol. 2005 Feb;42(2):202-9.

Indication of liver transplantation following amatoxin intoxication.

Author information

1
Toxicological Department, II Medizinische Klinik, Klinikum rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany. m.ganzert@Lrz.tu-muenchen.de

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.

PMID:
15664245
DOI:
10.1016/j.jhep.2004.10.023
[Indexed for MEDLINE]

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