Evidence map›Paper›PMID 41163058›Full record

ArticleCritical care (London, England)2025

Therapeutic plasma exchange in amatoxin associated acute liver failure-results from the multi-center Amanita-PEX study.

Klaus Stahl, Bahar Nalbant, Thorben Pape, Isaure Breteau, Valentin Coirier, Filipe S Cardoso, Jubi de Haan, Maciej K Janik, Jan-Christian Wasmuth, João Madaleno and 48 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

58 authors.

Klaus Stahl *Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany. stahl.klaus@mh-hannover.de.
Bahar Nalbant *Department of Respiratory Medicine and Infectious Diseases, and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany.
Thorben Pape *Department of Respiratory Medicine and Infectious Diseases, and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany.
Isaure BreteauDepartment of Anesthesia and Intensive Care, University Hospitals of Tours, Tours, France.
Valentin CoirierLiver Department, Médecine Intensive Réanimation, Rennes University Hospital, Rennes, France.
Filipe S CardosoCurry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
Jubi de HaanEuropean Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.
Maciej K JanikLiver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland.
Jan-Christian WasmuthDepartment of Internal Medicine I, German Center for Infection Research (DZIF), University of Bonn, Bonn, Germany.
João MadalenoLiver Disease Unit - Internal Medicine Department and Adult Liver Transplant Unit, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
Uta MerleMedical Faculty, Department of Internal Medicine IV, Heidelberg University, University Hospital, Heidelberg, Germany.
Josephine FrohmeDepartment of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Phil-Robin TepasseDepartment of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, Muenster, Germany.
Martina MüllerDepartment of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
Karsten GroßeDepartment of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
Alexandra LinkeDepartment of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Nikola MareljicDepartment of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
Fin Stolze LarsenDepartment of Hepatology and Gastroenterology, Rigshospitalet, Copenhagen University Hospitalet, Copenhagen, Denmark.
Gérladine DahlqvistService d'Hépato-gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Mirjam KolevDepartment of Visceral Surgery and Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
Marie SchulzeDepartment of Internal Medicine II, Hepatology, University Hospital of Würzburg, Würzburg, Germany.
Katharina WilluweitDepartment of Gastroenterology, Hepatology and Transplantational Medicine University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
Petra Janke-MaierDepartment of Gastroenterology, Gastrointestinal Onkology, Hepatology, Infektious Diseases,and Geriatrics, University of Tuebingen, Tuebingen, Germany.
Felix DondorfDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
Óscar M Fierro-AnguloDivision of Hepatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Anja GeertsDepartment of Gastroenterology & Hepatology, Ghent University Hospital, Ghent, Belgium.
David ToapantaLiver Unit, IDIBAPS, and CIBEREHD, Liver ICU, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Camille DejeanDepartment of Anesthesia and Intensive Care, University Hospitals of Tours, Tours, France.
Mohamed AlharthiLiver Department, Médecine Intensive Réanimation, Rennes University Hospital, Rennes, France.
Enric ReverterLiver Unit, IDIBAPS, and CIBEREHD, Liver ICU, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Heiko SchenkEuropean Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.
Sarah RaevensDepartment of Gastroenterology & Hepatology, Ghent University Hospital, Ghent, Belgium.
Ricardo Ulises Macías-RodríguezDivision of Hepatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Falk RauchfußDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
Christoph P BergDepartment of Gastroenterology, Gastrointestinal Onkology, Hepatology, Infektious Diseases,and Geriatrics, University of Tuebingen, Tuebingen, Germany.
Hartmut SchmidtDepartment of Gastroenterology, Hepatology and Transplantational Medicine University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
Andreas GeierDepartment of Internal Medicine II, Hepatology, University Hospital of Würzburg, Würzburg, Germany.
Nasser SemmoDepartment of Visceral Surgery and Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
Nicolas LanthierService d'Hépato-gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Peter N BjerringDepartment of Hepatology and Gastroenterology, Rigshospitalet, Copenhagen University Hospitalet, Copenhagen, Denmark.
Christian M LangeDepartment of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
Martina SterneckDepartment of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Tony BrunsDepartment of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
Stephan SchmidDepartment of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
Dominik van de LooDepartment of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, Muenster, Germany.
Münevver DemirDepartment of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Tobias BoettlerDepartment of Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
Catarina BorgesApheresis Unit - Blood and Transfusion Medicine Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
Jacob NattermannDepartment of Internal Medicine I, German Center for Infection Research (DZIF), University of Bonn, Bonn, Germany.
Karolina WronkaLiver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland.
Caroline M den HoedDepartment of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Hugo P MarquesCurry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
Florent ArtruLiver Department, Médecine Intensive Réanimation, Rennes University Hospital, Rennes, France.
Eric LevesqueDepartment of Anesthesia and Intensive Care, University Hospitals of Tours, Tours, France.
Heiner WedemeyerDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany.
Alejandro Campos-MurguiaDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany.
Richard TaubertDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, Hannover, 30625, Germany. taubert.richard@mh-hannover.de.
Amanita-PEX-study group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

AmanitinsLiver Failure, AcutePlasma ExchangeAdultAgedAmanitaFemaleHumansMaleMiddle AgedMushroom PoisoningRetrospective StudiesAmanitinsamatoxinAmanitaLiver failureLiver transplantationMushroom poisoningPlasma exchange

Identifiers

PMID41163058
PMCPMC12573913

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.