King's College Criteria

Criteria for liver transplantation in acute liver failure

King's College Criteria

The King's College Criteria are a set of guidelines used to determine the prognosis of patients with acute liver failure and to assess the need for liver transplantation. Developed at King's College Hospital in London, these criteria are widely used in clinical practice to identify patients who are unlikely to survive without a liver transplant.

Background

Acute liver failure is a rapid deterioration of liver function, resulting in coagulopathy and alteration in the mental status of a previously healthy individual. The condition can be caused by various factors, including drug-induced liver injury, viral hepatitis, and ingestion of toxic substances such as Amanita phalloides.

File:Amanita phalloides 1.JPG

Amanita phalloides, a toxic mushroom

The King's College Criteria were developed to help clinicians decide which patients with acute liver failure are most likely to benefit from liver transplantation. The criteria are based on clinical and laboratory parameters that have been shown to correlate with poor outcomes in acute liver failure.

Criteria

The King's College Criteria are divided into two main categories based on the etiology of the liver failure: paracetamol (acetaminophen) overdose and non-paracetamol causes.

Paracetamol Overdose

For patients with acute liver failure due to paracetamol overdose, the criteria include:

• Arterial pH < 7.3, 24 hours after ingestion
• OR all of the following:

 * Prothrombin time (PT) > 100 seconds
 * Serum creatinine > 300 µmol/L (3.4 mg/dL)
 * Grade III or IV hepatic encephalopathy

File:Acetaminophen metabolism.jpg

Acetaminophen metabolism

Non-Paracetamol Causes

For patients with acute liver failure from causes other than paracetamol, the criteria include:

• PT > 100 seconds
• OR any three of the following:

 * Age < 10 or > 40 years
 * Non-A, non-B hepatitis, drug-induced liver failure, or indeterminate cause
 * Duration of jaundice before encephalopathy > 7 days
 * PT > 50 seconds
 * Serum bilirubin > 300 µmol/L (17.5 mg/dL)

Application

The King's College Criteria are used to guide the decision-making process for liver transplantation in patients with acute liver failure. Patients meeting these criteria are considered to have a poor prognosis without transplantation and are typically prioritized for liver transplant evaluation.

Limitations

While the King's College Criteria are a valuable tool in assessing the need for liver transplantation, they are not without limitations. The criteria may not be applicable to all patient populations, and clinical judgment should always be used in conjunction with these guidelines.

Related pages

• Liver transplantation
• Acute liver failure
• Hepatic encephalopathy
• Prothrombin time