need for liver transplantation in liver failure

Last reviewed 01/2018

Criteria for the need for liver transplantation vary with respect to aetiology of the liver failure.

In paracetamol poisoning (acetaminophen poisoning), liver transplantation is indicated if:

• the blood pH is less than 7.3, or,
• in patients with grade III or IV encephalopathy, the prothrombin time is more than 100 secs and serum creatinine more than 300 micromol/litre

In all other causes of acute liver failure immediate liver transplantation is indicated if:

• prothrombin time more than 100 secs (irrespective of degree of encephalopathy), or:
• three of the following:
• age less than 10 years or more than 40 years
• prothrombin time more than 50 secs
• serum bilirubin more than 17.5 mg/dl
• jaundice was present for 7 days before the onset of encephalopathy
• liver failure is a result of either non-A, non-B hepatitis, halothane-induced hepatitis, or an idiosyncratic drug reaction