2024-10-23 16:46:00
Three people have had liver transplants again after severe mushroom poisoning. A liver specialist explains what toxic mushrooms do to organs and why you need to pay special attention to the kidneys too.
Professor Heiner Wedemeyer deals with inflammatory and viral diseases of the liver and gastrointestinal tract. Since 2020 he has been director of the gastroenterology, hepatology, infectious disease and endocrinology clinic at Hanover Medical School.
BRUISE: What makes the deadly cap mushroom so extremely dangerous?
Heiner Wedemeyer: These are in particular the highly toxic amatoxins. They cause serious liver damage. Even a small amount of the fungus is enough to put your life at risk. If you bite into a large deadly mushroom, you will get so much poison that it will be enough to kill you. And it makes no difference whether the mushroom was eaten raw, previously fried or boiled, because the toxins contained in the death cap mushroom are heat stable. Moreover, the course of poisoning is insidious.
BRUISE: What are the first signs of Death Cap poisoning?
Wedemeyer: You don’t notice it right away. It usually takes four to six hours, but sometimes it takes longer for the first symptoms to appear. Initially these are non-specific gastrointestinal disorders such as vomiting, nausea and diarrhea. The tricky thing is that they initially get better after a day or two. This was only the prelude, because at this point the amatoxins had already reached the liver and entered the liver cells there. The damage to the liver and kidneys then progresses without initially being noticed. Only after two to four days do symptoms that indicate liver damage appear: jaundice, dark urine, internal bleeding, weakness, confusion and liver failure.
BRUISE: What can you do then?
Wedemeyer: To mitigate this, you should treat with dissolved activated carbon as soon as possible. It binds amatoxins in the digestive tract before they enter the blood. The milk thistle preparation, silibinin, somewhat inhibits toxic effects in cells. The time factor is extremely important. Those who wait run a high risk of not surviving.
BRUISE: What exactly do mushroom toxins do to the body?
Wedemeyer: On the one hand, Death Cap mushrooms contain phallotoxins, which cause typical gastrointestinal symptoms such as diarrhea and vomiting at the onset of mushroom poisoning. They cause the cells of the intestinal lining to dissolve. A lot of liquid is released. However, amatoxins are significantly more dangerous than phallotoxins. They are absorbed from the intestine into the blood and can lead to serious organ dysfunction. Amatoxins block an enzyme in cells that is necessary for the protein to be made. Even the kidney, as an excretory organ, does not remain intact. Since amatoxins also damage kidney cells, they also die. In the worst case, multiple organ failure can occur.
BRUISE: Why is the liver especially so severely affected?
Wedemeyer: When amatoxins are absorbed from the digestive tract into the blood, they reach the liver directly through the portal vein. Since the liver is heavily supplied with blood, a large amount of mushroom poison arrives, like a tsunami. THE The effect of amatoxins leads to the inhibition or even arrest of protein synthesis in liver cells. Many liver cells can no longer carry out their tasks, inflammatory reactions occur and liver cells die.
BRUISE: What’s the next step?
Wedemeyer: This then leads to fulminant progression and even acute liver failure. As a result, he is temporarily paralyzed. If liver function is severely damaged, this has negative consequences for the rest of the organism. After all, the liver is the most important human organ. It’s a power plant, storage facility and wastewater treatment plant all in one. As a wastewater treatment plant and filter for poisonous substances and pollutants, it plays a central role in the “detoxification” of the blood.
BRUISE: Why in this case could livers be transplanted so quickly, while other people sometimes wait years for a new organ?
Wedemeyer: If the liver is severely damaged, treating doctors are faced with the question: does the organ have a chance to regenerate or will it deteriorate. In the latter case, only a liver transplant can help. This is a clinical challenge in everyday life. Experience, clinical scores, laboratory values, parameters that indicate whether a transplant is necessary. Maybe repeated plasmapheresis is enough?
BRUISE: You have to explain it.
Wedemeyer: This is a procedure for exchanging blood plasma. We don’t want to transplant a liver unnecessarily. After all, donated organs are an extremely scarce resource, but we also want the patient to survive.
BRUISE: How do you proceed then?
Wedemeyer: In particularly critical cases, such as acute liver failure following Death Cap poisoning, there is the possibility of reporting the patient to Eurotransplant as a high urgency (HU) case. Then there is the possibility of receiving a donor liver or, in the case of children, a liver lobe within a few hours or days. But it’s not that easy. Everything has to be right: blood type, organ size, especially in children, and you can’t implant an 80-year-old’s liver into a child. Someone may only be reported as a high urgency case if they have not previously had chronic liver damage, such as progressive liver scarring or liver cirrhosis. The people treated at the University Hospital Essen were registered in HU. That’s why, fortunately, they received an organ from a donor so quickly.
BRUISE: What are the chances of survival after a transplant in case of Death Cap poisoning?
Wedemeyer: Patients receive a healthy liver transplant. The only problems can arise due to immunosuppression. A suppressed immune system increases the risk of infections, but also cancer. But it is necessary to prevent a rejection reaction. However, the survival prospects of transplant recipients are good. They normally live with the donated organ for 20, 30, 40 years.
BRUISE: Won’t the kidneys also be damaged?
Wedemeyer: Yes, unfortunately the fungal toxin can also damage the kidneys. The toxicity of amatoxins to the kidneys is sometimes underestimated. It should be treated accordingly from the onset of poisoning. About two years ago, one of our patients received a donor liver. Unfortunately, his kidney has not recovered from the wave of poison, so he will need long-term kidney dialysis.
BRUISE: Do other fungi cause equally serious diseases?
Wedemeyer: Not regarding liver damage. There are various other fungi that cause gastrointestinal symptoms. But severe liver failure occurs specifically with death cap fungus. Amatoxins simply have a catastrophic effect on liver cells. It is therefore advisable to have the contents of a basket of mushrooms examined by an expert before eating them. He has an expert eye for killer mushrooms.
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