Hendrik PM, Schomacher T, Baier P, Gabriëls G, Pavenstädt H, Schmidt HHJ

Language: English
References: 32
Page: 775-787
PDF size: 202.28 Kb.

ABSTRACT

Amanita phalloides is the most relevant mushroom intoxication leading to acute liver failure. The two principal groups of toxins, the amatoxins and the phallotoxins, are small oligopeptides highly resistant to chemical and physical influences. The amatoxins inhibit eukaryotic RNA polymerase II causing transcription arrest affecting mainly metabolically highly active cells like hepatocytes and renal cells. The clinically most characteristic symptom is a 6-40 h lag phase before onset of gastrointestinal symptoms and the rapid progression of acute liver failure leading to multi-organ failure and death within a week if left untreated. Extracorporeal albumin dialysis (ECAD) was reported to improve patient’s outcome or facilitate bridging to transplantation. In our tertiary center, out of nine intoxicated individuals from five non-related families six patients presented with acute liver injury; all of them were treated with ECAD using the MARS^® system. Four of them were listed on admission for high urgency liver transplantation. In addition to standard medical treatment for Amanita intoxication we initiated ECAD once patients were admitted to our center. Overall 16 dialysis sessions were performed. All patients survived with full native liver recovery without the need for transplantation. ECAD was well tolerated; no severe adverse events were reported during treatment. Coagulopathy resolved within days in all patients, and acute kidney injury in all but one individual. In conclusion, ECAD is highly effective in treating intoxication with Amanita phalloides. Based on these experiences we suggest early initiation and repeated sessions depending on response to ECAD with the chance of avoiding liver transplantation.

REFERENCES

1. Lee WM, Squires RH, Jr., Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: Summary of a workshop. Hepatology 2008;47:1401-1415.

2. Vetter J. Toxins of Amanita phalloides. Toxicon 1998; 36: 13-24.

3. Walton JD, Hallen-Adams HE, Luo H. Ribosomal biosynthesis of the cyclic peptide toxins of Amanita mushrooms. Biopolymers 2010; 94: 659-64.

4. Santi L, Maggioli C, Mastroroberto M, Tufoni M, Napoli L, Caraceni P. Acute Liver Failure Caused by Amanita phalloides Poisoning. Int J Hepatol 2012; 2012: 480-7.

5. Stange J, Mitzner S, Ramlow W, Gliesche T, Hickstein H, Schmidt R. A new procedure for the removal of protein bound drugs and toxins. Asaio J 1993; 39: M621-M625.

6. Falkenhagen D, Strobl W, Vogt G, Schrefl A, Linsberger I, Gerner FJ, Schoenhofen M. Fractionated plasma separation and adsorption system: a novel system for blood purification to remove albumin bound substances. Artif Organs 1999; 23: 81-6.

7. Rifai K, Ernst T, Kretschmer U, Bahr MJ, Schneider A, Hafer C, Haller H, et al. Prometheus—a new extracorporeal system for the treatment of liver failure. J Hepatol 2003; 39: 984-90.

8. Wauters J, Wilmer A. Albumin dialysis: current practice and future options. Liver Int 2011; 31(Suppl. 3): 9-12.

9. Rifai K. Fractionated plasma separation and adsorption: current practice and future options. Liver Int 2011; 31(Suppl. 3): 13-5.

10. Krisper P, Stadlbauer V, Stauber RE. Clearing of toxic substances: are there differences between the available liver support devices? Liver Int 2011; 31(Suppl. 3): 5-8.

11. Mitzner SR, Stange J, Klammt S, Koball S, Hickstein H, Reisinger EC. Albumin dialysis MARS: knowledge from 10 years of clinical investigation. Asaio J 2009; 55: 498-502.

12. Jaeger A, Jehl F, Flesch F, Sauder P, Kopferschmitt J. Kinetics of amatoxins in human poisoning: therapeutic implications. J Toxicol Clin Toxicol 1993; 31: 63-80.

13. Faulstich H, Talas A, Wellhoner HH. Toxicokinetics of labeled amatoxins in the dog. Arch Toxicol 1985; 56: 190-4.

14. Fiume L, Sperti S, Montanaro L, Busi C, Costantino D. Amanitins do not bind to serum albumin. Lancet 1977; 1: 1111.

15. Camus C, Lavoue S, Gacouin A, Compagnon P, Boudjema K, Jacquelinet C, Thomas R, et al. Liver transplantation avoided in patients with fulminant hepatic failure who received albumin dialysis with the molecular adsorbent recirculating system while on the waiting list: impact of the duration of therapy. Ther Apher Dial 2009; 13: 549-55.

16. Camus C, Lavoue S, Gacouin A, Le Tulzo Y, Lorho R, Boudjema K, Jacquelinet C, et al. Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation. Intensive Care Med 2006;32: 1817-25.

17. Kantola T, Ilmakunnas M, Koivusalo AM, Isoniemi H. Bridging therapies and liver transplantation in acute liver failure, 10 years of MARS experience from Finland. Scand J Surg 2011; 100: 8-13.

18. Cisneros-Garza LE, Munoz-Ramirez M del R, Munoz-Espinoza LE, Ruiz Velasco JA, Moreno-Alcantar R, Marin-Lopez E, Mendez-Sanchez N. The molecular adsorbent recirculating system as a liver support system: summary of Mexican experience. Ann Hepatol 2014; 13: 240-7.

19. Stange J. Extracorporeal liver support. Organogenesis 2011; 7: 64-73.

20. Kaiser T, Kinny-Koster B, Bartels M, Parthaune T, Schmidt M, Thiery J. Impact of different creatinine measurement methods on liver transplant allocation. PLoS One 2014; 9: e90015.

21. Kantola T, Kantola T, Koivusalo AM, Hockerstedt K, Isoniemi H. Early molecular adsorbents recirculating system treatment of Amanita mushroom poisoning. Ther Apher Dial 2009; 13: 399-403.

22. Bergis D, Friedrich-Rust M, Zeuzem S, Betz C, Sarrazin C, Bojunga J. Treatment of Amanita phalloides intoxication by fractionated plasma separation and adsorption [Prometheus(R)]. J Gastrointestin Liver Dis 2012; 21: 171-6.

23. Enjalbert F, Rapior S, Nouguier-Soule J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol 2002; 40: 715-57.

24. Willars C. Update in intensive care medicine: acute liver failure. Initial management, supportive treatment and who to transplant. Curr Opin Crit Care 2014; 20: 202-9.

25. Faybik P, Hetz H, Baker A, Bittermann C, Berlakovich G, Werba A, Krenn CG, et al. Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning. Liver Int 2003;23 (Suppl. 3): 28-33.

26. Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Volovat C, Dimitriu AG, Cristogel F, Bizo A. Successful use of Molecular Absorbent Regenerating System (MARS) dialysis for the treatment of fulminant hepatic failure in children accidentally poisoned by toxic mushroom ingestion. Liver Int 2003;23 (Suppl. 3): 21-7.

27. Sorodoc L, Lionte C, Sorodoc V, Petris O, Jaba I. Is MARS system enough for A. phalloides-induced liver failure treatment? Hum Exp Toxicol 2010; 29: 823-32.

28. Dominik A, Stange J, Pfensig C, Borufka L, Weiss-Reining H, Eggert M. Reduction of elevated cytokine levels in acute/ acute-on-chronic liver failure using super-large pore albumin dialysis treatment: an in vitro study. Ther Apher Dial 2014; 18: 347-52.

29. Pfensig C, Dominik A, Borufka L, Hinz M, Stange J, Eggert M. A New Application for Albumin Dialysis in Extracorporeal Organ Support: Characterization of a Putative Interaction Between Human Albumin and Proinflammatory Cytokines IL-6 and TNFalpha. Artif Organs 2015.

30. Donati G, La Manna G, Cianciolo G, Grandinetti V, Carretta E, Cappuccilli M, Panicali L, et al. Extracorporeal detoxification for hepatic failure using molecular adsorbent recirculating system: depurative efficiency and clinical results in a longterm follow-up. Artif Organs 2014; 38: 125-34.

31. Banares R, Nevens F, Larsen FS, Jalan R, Albillos A, Dollinger M, Saliba F, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-onchronic liver failure: the RELIEF trial. Hepatology 2013; 57: 1153-62.

32. Vesconi S, Langer M, Iapichino G, Costantino D, Busi C, Fiume L. Therapy of cytotoxic mushroom intoxication. Crit Care Med 1985; 13: 402-6.