{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T16:11:54Z","timestamp":1788192714305,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,3,4]],"date-time":"2016-03-04T00:00:00Z","timestamp":1457049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U\u201001 58369"],"award-info":[{"award-number":["U\u201001 58369"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Published estimates of survival associated with mushroom (amatoxin)\u2010induced acute liver failure (<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content>) and injury (<jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content>) with and without liver transplant (<jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>) are highly variable. We aimed to determine the 21\u2010day survival associated with amatoxin\u2010induced <jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content> (A\u2010<jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> (A\u2010<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content>) and review use of targeted therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cohort study of all A\u2010<jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content>\/A\u2010<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> patients enrolled in the <jats:styled-content style=\"fixed-case\">US ALFSG<\/jats:styled-content> registry between 01\/1998 and 12\/2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2224 subjects in the registry, 18 (0.8%) had A\u2010<jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> (<jats:italic>n<\/jats:italic> = 13) or A\u2010<jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content> (<jats:italic>n<\/jats:italic> = 5). At admission, <jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> patients had higher lactate levels (5.2 vs. 2.2 m<jats:sc>m<\/jats:sc>,<jats:italic> P<\/jats:italic> = 0.06) compared to <jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content> patients, but <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> (2.8 vs. 2.2), bilirubin (87 vs. 26 \u03bc<jats:sc>m<\/jats:sc>) and <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content> scores (28 vs. 24) were similar (<jats:italic>P<\/jats:italic> &gt; 0.2 for all). Of the 13 patients with <jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content>, six survived without <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> (46%), five survived with <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> (39%) and two died without <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> (15%). Of the five patients with <jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content>, four (80%) recovered and one (20%) survived post\u2010<jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>. Comparing those who died\/received <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> (non\u2010spontaneous survivors [<jats:styled-content style=\"fixed-case\">NSS<\/jats:styled-content>]) with spontaneous survivors (<jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>), <jats:italic>N<\/jats:italic>\u2010acetylcysteine was used in nearly all patients (<jats:styled-content style=\"fixed-case\">NSS<\/jats:styled-content> 88% vs. <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content> 80%); whereas, silibinin (25% vs. 50%), penicillin (50% vs. 25%) and nasobiliary drainage (0 vs. 10%) were used less frequently (<jats:italic>P<\/jats:italic> &gt; 0.15 for all therapies).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with mushroom poisoning with <jats:styled-content style=\"fixed-case\">ALI<\/jats:styled-content> have favourable survival, while around half of those presenting with <jats:styled-content style=\"fixed-case\">ALF<\/jats:styled-content> may eventually require <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13080","type":"journal-article","created":{"date-parts":[[2016,2,2]],"date-time":"2016-02-02T14:06:49Z","timestamp":1454422009000},"page":"1043-1050","source":"Crossref","is-referenced-by-count":73,"title":["Acute liver injury and acute liver failure from mushroom poisoning in <scp>N<\/scp>orth <scp>A<\/scp>merica"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1555-1089","authenticated-orcid":false,"given":"Constantine J.","family":"Karvellas","sequence":"first","affiliation":[{"name":"Divisions of Hepatology and Critical Care Medicine University of Alberta Edmonton AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Tillman","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism University of Calgary Calgary AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Schilsky","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases and Transplant and Immunology Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Hameed","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of California San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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