The Intractable Liver Diseases Study Group of Japan reported criteria for liver transplantation in a patient with acute or fulminant hepatic failure.
Patient selection: acute or fulminant hepatic failure, with Grade II to V encephalopathy
Indications for being placed on the liver transplant registry waiting list - 2 or more of the following:
(1) age >= 45 years
(2) interval from appearance of initial symptoms to onset of hepatic encephalopathy >= 11 days
(3) prothrombin activity < 10% of standardized value
(4) serum total bilirubin concentration >= 18.0 mg/dL
(5) ratio of direct to total serum bilirubin concentration < 0.67
Indications for being removed from the liver transplant registry waiting list - all of the following:
(1) liver transplant not performed within 5 days of intensive medical therapy and the patient is still alive
(2) hepatic encephalopathy either (a) 0 or 1, or (b) decrease in 2 or more grades (from V to III or less, etc)
(3) prothrombin activity increases, to > 50% of the standardized value
where:
• Since the baseline encephalopathy is from 2 to 5, the possible changes are:
|
Baseline
|
Followup
|
|
2
|
0
|
|
3
|
<= 1
|
|
4
|
<= 2
|
|
5
|
<= 3
|
