Efficacy of Fractionated Plasma Separation and Adsorption System (Prometheus) for Treatment of Liver Failure Due to Mushroom Poisoning

摘要

Background/Aims: Consuming wild mushrooms is an ordinary habit in lato summer and autumn in our region. Every year, several cases of hepatic toxicity secondary to mushroom poisoning are observed because of poor identification of the mushrooms. Unfortunately some of them are fatal. Prometheus system is a newly developed ex-tracorporoal liver support device for fractionated plasma separation and adsorption (FPSA) that enables removal of albumin-bound and water-soluble toxins. Therefore, it may be a promising treatment option for patients with liver failure due to mushroom poisoning.Methodology: We studied 8 patients with mushroom poisoning. All patients underwent 1 to 4 consecutive FPSA (Promethous)-system in addition to medical and supportive treatment such as fluid replacement, Penicillin G, N-acetylcysteine (NAG) and silymarin. A variety of clinical and biochemical parameters wore assessed. Results: We had improvement of the biochemical parameters after first treatment with FPSA-system. Seven of 8 patients survived and were discharged to resume an independent life. One patient who had grade III encephalopathy when admitted to hospital died. No major adverse events were observed during the application of this therapy modality.Conclusions: FPSA-system may be a safe and effective treatment option for patient with mushroom poisoning. Early hospitali'/ation is essential in order to bo successful. Controlled studies are needed to evaluate the efficacy of this new treatment choice on survival of patients with acute liver failure (ALF) due to mushroom poisoning.