Need for liver transplantation in liver failure

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