Elimination Capacity Determines Outcome in Amatoxin Mushroom Poisoning-Induced Acute Liver Failure: A Globally Applicable Management Framework

ABSTRACT Amatoxin mushroom poisoning causes acute liver failure; progression from cholera-like hypovolemia resolution to fatal multisystem collapse occurs unpredictably. We conducted a prospective single-arm multicenter trial (N=99) investigating proactive toxicokinetic-based management: sustained hydration for renal protection and clearance preservation, fasting plus octreotide to arrest enterohepatic circulation, and intravenous silibinin to block hepatic reuptake. Transplant-free recovery: 98.8% among protocol-adherent patients (n=86). Multivariable analysis: sustained hydration (P