During autumn mushroom season it occasionally happens that people mistake poisonous mushrooms for edible ones during privately mushroom picking in German forests. Especially families from the middle east that know similar edible mushrooms from their home country. Amatoxin poisoning results in acute mostly irreversible liver failure.

Patients and Methods:

Between summer 2024 and august 2025 we admitted 4 children for acute liver failure after accidental ingestion of poisonous mushrooms (death cap mushroom, Amanita phalloides).

2 of the children recovered without the need for liver transplantation. 2 children needed urgent liver transplantation. Patients were placed on plasmapheresis prior to transplant. One child received a whole liver graft. The other 12-year-old child received a right extended lobe graft which was placed on hypothermic oxygenated machine perfusion (HOPE) prior to transplant, because of long cold ischemic time and steatosis.The graft was reconstruced microvasculry in order to allow canulation of the artery.

Results:

All patients survived. The child who received the partial graft had a bile leakage that was drained interventionally. All patients were discharged home and are doing well during the follow up period.

Conclusions:

Amatoxin induced acute liver failure can be reversible if a low amount of toxin is ingested. Most patients however need urgent liver transplantation. If needed, marginal grafts can be accepted. Machine perfusion can minimize the risks of reperfusion syndrome even in partial liver grafts, however good experience in microvascular reconstruction is required to place partial grafts on machine perfusion.