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

BACKGROUND: Amatoxin-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. METHODS: The 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. RESULTS: The 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 

• Stahl, K.
• Nalbant, B.
• Pape, T.
• Breteau, I.
• Coirier, V.
• Cardoso, F. S.
• de Haan, J.
• Janik, M. K.
• Wasmuth, J. C.
• Madaleno, J.
• Merle, U.
• Frohme, J.
• Tepasse, P. R.
• Müller, M.
• Große, K.
• Linke, A.
• Mareljic, N.
• Larsen, F. S.
• Dahlqvist, G.
• Kolev, M.
• Schulze, M.
• Willuweit, K.
• Janke-Maier, P.
• Dondorf, F.
• Fierro-Angulo Ó, M.
• Geerts, A.
• Toapanta, D.
• Dejean, C.
• Alharthi, M.
• Reverter, E.
• Schenk, H.
• Raevens, S.
• Macías-Rodríguez, R. U.
• Rauchfuß, F.
• Berg, C. P.
• Schmidt, H.
• Geier, A.
• Semmo, N.
• Lanthier, N.
• Bjerring, P. N.
• Lange, C. M.
• Sterneck, M.
• Bruns, T.
• Schmid, S.
• van de Loo, D.
• Demir, M.
• Boettler, T.
• Borges, C.
• Nattermann, J.
• Wronka, K.
• den Hoed, C. M.
• Marques, H. P.
• Artru, F.
• Levesque, E.
• Wedemeyer, H.
• Campos-Murguia, A.
• Taubert, R.