Significance and Outcome of Living-donor Liver Transplantation in Acute Mushroom Intoxication

Introduction: Mushroom intoxication ( MT) can lead to acute liver injury which may result in Mushroom intoxication-related liver failure ( M-ALF) requiring liver transplantation ( LT). In the present study, we want to share the experience of our institute regarding living-donor LT ( LDLT) due to mushroom poisoning. Aim: The aim of this study is to identify the predictors of poor prognosis in patients with ALF secondary to mushroom intoxication requiring LDLT. Materials and Methods: All patients with MT between 2008 and 2016 were evaluated. Demographics, symptoms, interval between symptoms and admission to our institute, laboratory data, model for end-stage liver disease ( MELD)/ pediatric end-stage liver disease ( PELD) scores, clinical course, and outcomes of supportive therapy and LT were evaluated. There were two groups in the study: Group A = responsive to supportive therapy ( n = 9) versus Group B = unresponsive to supportive therapy ( n = 9). Results: During the study, a total of 18 patients were admitted with M-ALF. Twelve ( 66.7%) of them were female, and the mean age was 39.9 +/- 18.2 years. All of the nine patients in Group A fully recovered with supportive therapy. In Group B, one patient died during waiting period for LT and 8 patients received LDLT LDLT. Three of the eight patients who were transplanted died in the postoperative early period within postoperative 5 days. The patients in Group B had significantly higher MELD/ PELD scores and encephalopathy rate than in Group A ( P < 0.05). International normalized ratio ( INR), bilirubin, ammonium levels, and platelet count were significantly different between groups ( P < 0.05). The patients in Group B had significantly longer interval before admission to our institute ( P < 0.05). Conclusion: The presence of encephalopathy, higher MELD/ PELD, INR, bilirubin, ammonium levels, and lower platelet count was related to poor prognosis in MT. LDLT provides a good therapeutic option in patients with M-ALF. The time is a crucial factor in successful treatment of MT. Early admission to a tertiary referral center with expertise in LT results in a better prognosis and increased survival following M-ALF.