Survival Analysis of Liver Transplants in Patients with Acute Liver Failure from Acetaminophen and Mushroom Toxicity

BACKGROUND Acute liver failure (ALF) remains a critical concern, accounting for about 8% of all liver transplants, with acetaminophen overdose contributing to nearly half of these cases. Besides synthetic toxins, natural toxins such as phallotoxin from Amanita phalloides mushrooms also lead to severe hepatocyte damage. This study investigates the outcomes of liver transplantation (LT) as a life-saving intervention in patients suffering from ALF due to acetaminophen and Amanita phalloides poisoning. MATERIAL AND METHODS We conducted a retrospective analysis of 39 patients who underwent LT for ALF induced by acetaminophen (n=18) or A. phalloides (n=21) poisoning at the Medical University of Warsaw. Various statistical analyses, including logistic regression, Mann-Whitney-U, and chi-squared tests, were employed. Survival rates were determined using Kaplan-Meier analysis. RESULTS The cohort included 24 females and 15 males, with a median age of 41. The 90-day mortality rate was 22.2% for acetaminophen poisoning and 38.1% for A. phalloides poisoning (P=0.284), with an estimated 5-year survival rate of 59.6%. Key factors associated with increased 90-day mortality included the number of red blood cells transfused (OR 1.574 per unit; P=0.011), fresh frozen plasma units (OR 1.346 per unit; P=0.003), acute kidney failure requiring hemodialysis (OR 13.50; P=0.021), and days from listing to LT (OR 2.289 per day; P=0.013). CONCLUSIONS Liver transplantation for ALF, though inherently high-risk, offers substantial survival benefits. Outcomes are largely influenced by the patient's condition at the time of transplant, organ availability, and intraoperative management. Despite significant mortality risks, LT remains a crucial intervention for ALF due to acetaminophen and Amanita phalloides toxicity.