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Indications for liver transplantation

Authoring team

If the acute management of paracetamol poisoning is ineffective and fulminant hepatic necrosis ensues then liver transplantation is life-saving.

The indications for liver transplantation are:

  • acidosis (pH < 7.3), or
  • all of the following:
    • PT > 100 sec
    • creatinine > 300 mcg/l
    • grade 3 encephalopathy (or worse)

It is better to contact the local liver transplant centre earlier than this. Grossly abnormal prothrombin times should trigger referral:

  • PT > 20 sec at 24 hr
  • PT > 40 sec at 48 hr
  • if PT is between 20 and 40 sec at 48 hr then check the PT again at 72 hr; if PT is still > 20 sec then refer

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