Experience of Treatments of Amanita Phalloides-induced Fulminant Liver Failure with Molecular Adsorbent Recirculating System and Therapeutic Plasma Exchange

Abstract

Objective: To evaluate the effects of molecular adsorbent recirculating system (MARS) and therapeutic plasma exchange (TPE) on patients with amanita phalloides-induced fulminant liver failure. Material and Methods:We retrospectively analyzed nine cases of amanita phalloides poisoning where MARS and/or TPE was applied. Results:The survival rate for the nine patients in this study was 66.7%. Patients who received both MARS and TPE therapies experienced higher survival rates than those who received MARS or TPE alone (100% vs 0%, 50%). A single session of TPE produced greater improvements in ALT (-58.6% vs -12.5%), AST (-44.2% vs -26.9%), total bilirubin (-44.4% vs -12.5%), and PT (-51.2% vs -4.89%) compared to a single session of MARS (all p<0.05). Conclusion:The results suggest that TPE has better efficacy in removing toxins and improving liver functions. There is a trend that combined use of MARS and TPE may be more effective than either therapy alone, and early intervention may be more effective than delayed therapy. Additionally, the presence of severe hypoglycemia, severe liver failure, and renal failure indicated a worse outcome. (JAEM 2014; 13: 181-6)