Liver transplantation for severe Amanita phalloides mushroom poisoning

Article Abstract:

Case reports are presented of five victims of mushroom poisoning, four of whom received liver transplants. Death resulting from eating poisonous mushrooms, especially from Amanita phalloides, has decreased in general, but the rate of poisoning has increased recently in the United States. Criteria for transplantation are presented, as is a discussion of the effects of the poisoning. The five patients had eaten mushrooms gathered near the same area on the same day. Their initial symptoms, beginning approximately seven hours after consumption of the mushrooms, were cramps, nausea, vomiting, and profuse diarrhea leading to dehydration. They were hospitalized and treated with intravenous fluid, electrolytes, and antibiotics. Gastrointestinal hemorrhage (bleeding into the digestive tract) developed in four patients, with marked abnormalities of the blood clotting process. When significant liver dysfunction became obvious on the third day, four patients became transplantation candidates. The fifth patient did not appear as seriously ill as the others. Criteria for transplantation included a prolonged prothrombin time (a measure of blood clotting); elevated levels of enzymes indicative of liver dysfunction; increased levels of ammonia; and other symptoms. Between eight and 64 hours were required to find donors. The diseased livers showed considerable pathological change, which is described. The patients received immunosuppressant drugs and other agents, and one year later, all the patients were doing well, and had resumed normal activities. Maintenance of fluid and electrolyte balance is critical in treating poisoned patients. Involvement of a transplant center early in the care of such patients requires accurate identification of patients who will have the best results. If indicated, the operation should proceed as soon as possible, before the effects of liver failure become more widespread. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Case studies, Poisoning, Accidental, Accidental poisoning, Mushrooms, Poisonous, Poisonous mushrooms, Amanita phalloides, Amanita

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Hepatitis C virus not found in fulminant non-A, non-B hepatitis

Article Abstract:

The development of immunological tools has permitted the laboratory testing for hepatitis A and hepatitis B. Cases of hepatitis that were neither A nor B have been appropriately referred to as non-A, non-B hepatitis. Another hepatitis virus, hepatitis C virus (HCV) has now been identified and implicated in the cause of non-A, non-B hepatitis resulting from blood transfusion or intravenous drug abuse. However, it is not clear how often hepatitis C virus plays a role in other cases of non-A, non-B hepatitis. In particular, it is not known whether HCV is responsible for fulminant non-A, non-B hepatitis. This form of hepatitis is marked by its severity and rapid onset. The condition often requires liver transplantation and fatalities are not uncommon. A study was conducted of 15 patients with acute liver failure who were referred for evaluation for liver transplantation. The case histories and immunological evaluation suggested fulminant non-A, non-B hepatitis. None of the 15 patients had antibodies against hepatitis C virus in their blood. However, since antibodies against hepatitis C may appear slowly and a long time after infection, the absence of these antibodies is not convincing evidence against HCV infection. For this reason, the sensitive polymerase chain reaction (PCR) was used to detect any traces of HCV genes that may have been present. Hepatitis C virus genes were found in none of the 15 patients, although the PCR technique successfully detected HCV genes in five of seven patients with cryptogenic cirrhosis who were included as controls to check the effectiveness of the PCR test. The results suggest that hepatitis C virus is not a common cause of sudden and severe non-A, non-B hepatitis, and may not even be associated with this type of hepatitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Development and progression, Hepatitis C, Hepatitis C virus, Hepatitis E

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Initial two-year results of the Oregon Liver Transplantation Program

Article Abstract:

Before 1987, there was no regional liver transplant service available to the 10 million people of the Pacific Northwest. In 1987 a liver transplantation program was established as a joint project of the Oregon Health Sciences University and the Portland Veterans Affairs Medical Center. The results of the first two years of operation are presented. There were 94 patients evaluated within the first two years of operation, and 47 adults underwent 54 liver transplantations (seven patients had a second liver transplant). The average patient age was 44 years, and 72 percent were men. Veterans accounted for 34 percent of the patients treated. The average operation lasted 7.4 hours, and the average hospital stay was 30 days. There were 15 biliary (gallbladder-related) complications, for a rate of 28 percent. One patient died (2 percent mortality) within the post-surgery period (the month following surgery). At one year, the survival rate was 80 percent. Patients with hepatitis B had the poorest outcome; four of six patients died after an average of 7.6 months. The overall rate of organ rejection was 55 percent. The reasons for failure of a transplantation were a nonfunctioning donor organ (three patients), uncontrolled organ rejection (two patients), and recurrence of hepatitis B (two patients). Of 25 patients able to be interviewed with regard to quality of life, 18 (72 percent) were able to perform their usual daily activities and work. An additional four patients were able to care for themselves and work part-time. (Consumer Summary produced by Reliance Medical Information, Inc.)

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