Prognosis and Transplantation
Table 5. Potentially Helpful Indicatorsa of Poor Prognosis in
Patients With ALF
Etiology
Idiosyncratic drug injury
Acute hepatitis B (and other non-hepatitis A viral infections)
Autoimmune hepatitis
Mushroom poisoning
Wilson disease
Budd-Chiari syndrome
Indeterminate cause
Coma Grade on Admission
III or IV
King���s College Criteria
Acetaminophen-Induced ALF
Strongly consider orthotopic liver transplantation (OLT) listing if:
������ Arterial lactate > 3.5 mmol/L after early fluid resuscitation
List for OLT if:
������ pH < 7.3 OR
������ Arterial lactate > 3.0 mmol/L after adequate fluid resuscitation
List for OLT if all 3 occur within a 24-hour period:
������ Presence of grade 3 or 4 hepatic encephalopathy
������ INR > 6.5
������ Creatinine > 3.4 mg/dL
Non-Acetaminophen-Induced ALF
List for OLT if:
������ INR > 6.5 and encephalopathy present (irrespective of grade) OR
������ Encephalopathy present, irrespective of grade, and any three of the following:
������ Age < 10 or > 40 yearsb
������ Jaundice for > 7 days before development of encephalopathyb
������ INR ��� 3.5
������ Serum bilirubin ��� 17 mg/dL
������ Unfavorable etiology, such as
���� Wilson Disease
���� Idiosyncratic drug reaction
���� Seronegative hepatitis
Please note: None of these factors, with the exception of Wilson Disease and possibly mushroom
poisoning, is either necessary or sufficient to indicate the need for immediate liver transplantation.
b
These criteria, in particular, have not been found to be predictive of outcome in recent analyses.
a
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