Stahl, Klaus and Nalbant, Bahar and Pape, Thorben and Breteau, Isaure and Coirier, Valentin and Cardoso, Filipe S. and De Haan, Jubi and Janik, Maciej K. and Wasmuth, Jan-Christian and Madaleno, Joao and Merle, Uta and Frohme, Josephine and Tepasse, Phil-Robin and Müller-Schilling, Martina and Grosse, Karsten and Linke, Alexandra and Mareljic, Nikola and Larsen, Fin Stolze and Dahlqvist, Gerladine and Kolev, Mirjam and Schulze, Marie and Willuweit, Katharina and Janke-Maier, Petra and Dondorf, Felix and Fierro-Angulo, Oscar M. and Geerts, Anja and Toapanta, David and Dejean, Camille and Alharthi, Mohamed and Reverter, Enric and Schenk, Heiko and Raevens, Sarah and Macias-Rodriguez, Ricardo Ulises and Rauchfuss, Falk and Berg, Christoph P. and Schmidt, Hartmut and Geier, Andreas and Semmo, Nasser and Lanthier, Nicolas and Bjerring, Peter N. and Lange, Christian M. and Sterneck, Martina and Bruns, Tony and Schmid, Stephan and Van De Loo, Dominik and Demir, Munevver and Boettler, Tobias and Borges, Catarina and Nattermann, Jacob and Wronka, Karolina and Den Hoed, Caroline M. and Marques, Hugo P. and Artru, Florent and Levesque, Eric and Wedemeyer, Heiner and Campos-Murguia, Alejandro and Taubert, Richard and Seeliger, Benjamin and Peiffer, Kai-Hendrik and Stockert, Petra and David, Sascha and Andermatt, Rea and Busch, Markus and Wiesner, Olaf and Maasoumy, Benjamin and Abu-Isneineh, Rene (2025) Therapeutic plasma exchange in amatoxin associated acute liver failure-results from the multi-center Amanita-PEX study. CRITICAL CARE, 29 (1): 458. ISSN 1364-8535, 1466-609X
Full text not available from this repository. (Request a copy)Abstract
BackgroundAmatoxin-related acute liver failure (AT-ALF) carries high mortality without liver transplantation (LTX). While therapeutic plasma exchange (PEX) might improve LTX-free survival in other ALF cases, its role in AT-ALF is unclear. Clinical practice varies, and, given the rarity of this ALF entity, the feasibility of conducting a randomized controlled trial to investigate PEX in AT-ALF is more or less impossible.MethodsThe Amanita-PEX study is a multi-center, international, retrospective study analyzing patients with AT-ALF from 2013 to 2024. The primary outcome was 28-day LTX-free survival (composite endpoint: death or LTX) after ALF diagnosis.ResultsThe study included 111 patients from 25 centers: 82 received standard-of-care (SOC), and 29 received at least one PEX-session. PEX and SOC-groups were comparable at baseline, but 76% of PEX- vs. 58% of SOC-patients developed hepatic-encephalopathy (HE) grade >= 2 (p = 0.021). While the primary outcome of 28-day LTX-free survival in all patients was not different between the SOC and PEX-groups, in the subgroup of patients with maximal HE grade >= 2, LTX-free survival was 19.1% (n = 8/42) in the SOC group, while it was 36.4% (n = 8/22) in patients receiving adjunctive PEX (Gehan-Breslow-Wilcoxon-p = 0.041, Log-Rank-p = 0.060). PEX was independently associated with reduced risk of the combined endpoint death or liver transplantation within 28 days from inclusion in patients with HE grade >= 2 (HR 0.37, 95%-CI 0.19-0.73, p = 0.004). After propensity-score-matching, LTX-free survival was 28% in the SOC- and 52% in the PEX group (Gehan-Breslow-p = 0.036; Log-Rank-p = 0.035).ConclusionsIn this real-world study, adjunctive use of PEX was associated with increased LTX-free-survival in patients with AT-ALF and HE grade >= 2.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | HIGH-VOLUME PLASMAPHERESIS; N-ACETYLCYSTEINE; SURVIVAL; Liver failure; Mushroom poisoning; Plasma exchange; Liver transplantation; Amanita |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin I |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Mar 2026 12:55 |
| Last Modified: | 24 Mar 2026 12:55 |
| URI: | https://pred.uni-regensburg.de/id/eprint/68067 |
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