Citation

Ates M, Dirican A, Ozgor D, Aydin C, Işık B, Ara C, Yilmaz M, Selimoğlu MA, Kayaalp C, Yilmaz S. Liver Transpl. 2011; 17(11): 1286-1291.

Affiliation

Department of General Surgery, Division of Liver Transplantation, Inonu University, Medical Faculty, Malatya, Turkey. drmustafaates@hotmail.com.

Copyright

(Copyright © 2011, John Wiley and Sons)

DOI

10.1002/lt.22384

PMID

21761550

Abstract

Yellow phosphorus is a protoplasmic toxicant that targets the liver. Ingestion of fireworks containing yellow phosphorus, either accidentally by children or by adults attempting suicide, often results in death due to acute liver failure. We present the outcomes of ten children ingested fireworks containing yellow phosphorus. The ten patients were six boys and four girls aged 20-60 months. One patient remained stable without liver complications and was discharged. Three patients died of hepatorenal failure and cardiovascular collapse, whereas living donor liver transplantation (LDLT) was performed in six patients. The patients had grade II-III encephalopathy, a mean alanine aminotransferase of 1147 IU/L, a mean aspartate transaminase of 1437.5 IU/L, a mean total bilirubin level of 7.5 µmol/dL, a mean international normalized ratio of 6.6, a mean pediatric end-stage liver disease score of 29.7, and a mean Child-Pugh score of 11.3. Postoperatively, two patients had persistent encephalopathy and died on the second postoperative day, and one patient (10%) died of cardiac arrest on the first postoperative day, despite a well functioning graft. The other three patients are still alive for a mean of 204 days. In conclusion, ingesting fireworks containing yellow phosphorus causes acute liver failure with a high mortality rate. When signs of irreversible acute liver failure are detected, emergency LDLT should be considered as a life-saving procedure; however, if yellow phosphorus toxicity affects both the brain and heart, in addition to the liver, mortality rates remain very high despite liver transplantation. Liver Transpl, 2011. © 2011 AASLD.

Language: en