Indications and Contraindications for Liver Transplantation

Table 5

Criteria for liver transplantation in acute liver failure (ALF).

(a) King’s College Criteria

Acetaminophen-induced ALF	Nonacetaminophen ALF
(1) Arterial pH < 7.3 irrespective of grade of encephalopathy	(1) INR > 6.5 (PT > 100 sec), irrespective of grade of encephalopathy
OR	OR any 3 of the following:
(1) PT > 100 sec	(1) INR > 3.5 (PT > 50 sec)
(2) Serum creatinine >3.4 mg/dL	(2) Age < 10 or >40 years
(3) Stage 3 or 4 encephalopathy	(3) Serum bilirubin >18 mg/dL
	(4)  Jaundice to encephalopathy interval >7 days
	(5)  Non-A, non-B hepatitis, idiosyncratic drug reaction

(b) Prognostic index in fulminant Wilsons hepatitis (WPI) [14]

Score	0	1	2	3	4
Serum bilirubin (reference range 3–20 mmol/L)	<100	100–150	151–200	201–300	>300
Serum aspartate transaminase (reference range 7–40 IU/L)	<100	100–150	151–200	201–300	>300
Prothrombin time prolongation (seconds)	<4	4–8	9–12	13–20	>30
Patients with a WPI score ≥7 need urgent liver transplantation

(c) Revised Wilson prognostic index (RWPI) [15]

Score	Bilirubin (μmol/L)	INR	AST (IU/L)	WCC (10^9/L)	Albumin (g/L)
0	0–100	0–1.29	0–100	0–6.7	>45
1	101–150	1.3–1.6	101–150	6.8–8.3	34–44
2	151–200	1.7–1.9	151–300	8.4–10.3	25–33
3	201–300	2.0–2.4	301–400	10.4–15.3	21–24
4	≥301	>2.5	>401	>15.4	<20
Patients with a RWPI ≥11 needed urgent liver transplantation

(d) Clichy criteria (Hospital Paul-Brousse, Villejuif [16])

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Hepatic encephalopathy, and factor V level:

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<20% in patients <30 years of age, or

<30% in patients ≥30 years of age

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