Successful treatment of an adult with Amanita phalloides-induced fulminant liver failure with molecular adsorbent recirculating system (MARS)

Rom J Gastroenterol. 2005 Sep;14(3):267-71.


Despite significant advances in intensive care management of Amanita phalloides-induced fulminant liver failure (FLF), patients with this condition still have a high mortality rate in the absence of orthotopic liver transplantation. Molecular Adsorbent Recirculating System (MARS) is a new, cell-free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin-bound toxins, and a highly effective depurative therapy in adults with wild mushroom-induced FLF. We report the case of a 39 year old woman with Amanita phalloides-induced FLF, admitted to our intensive care unit (ICU) and treated with MARS. Our patient had severe hepatic dysfunction: hepatic encephalopathy (grade II), ALT = 5022 (2475-10098) IU/L, bilirubin = 7.18 (4.8-10.1) mg/dL, prothrombin time (PT) = 90.4 (29.3-140.4) s. MARS sessions had an immediate impact on liver tests: statistically significant decrease in ammonia, ALT and PT. Hepatic encephalopathy was successfully reduced. The patient survived and the hepatic function completely recovered. MARS appears to be a safe and highly effective depurative therapy in adults with Amanita phalloides-induced FLF.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amanita / pathogenicity
  • Extracorporeal Circulation*
  • Female
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / therapy
  • Humans
  • Liver Failure, Acute / etiology
  • Liver Failure, Acute / therapy*
  • Mushroom Poisoning / complications*
  • Sorption Detoxification
  • Treatment Outcome