Paracetamol / Acetaminophen-Induced Acute Liver Failure | Criteria for Liver Transplantation

 

List for transplantation if one or more of the following is present:

(1) arterial pH < 7.3 after adequate fluid resuscitation (about 12 hours after hospital admission)

(2) arterial lactate concentration is > 3.0 mmol/L after adequate fluid resuscitation (about 12 hours after hospital admission)

(3) presence of all 3 of the following:

(3a) serum creatinine > 300 µmol/L (> 3.39 mg/dL)

(3b) INR > 6.5 (or PTT > 100 seconds)

(3c) hepatic encephalopathy of grade 3 or 4

 

Strongly consider listing for transplantation if:

(1) The arterial lactate concentration > 3.5 mmol/L after early fluid resuscitation (about 4 hours after admission to the hospital).

 

Performance:

• The addition of arterial lactate concentration to the criteria gives a positive likelihood ratio of 15, which is similar to the original KCH criteria. The negative likelihood ratio for the modified criteria was < 2% in the validation group, which is an improvement over the original criteria.