Unifying Concepts

King´s College Hospital Criteria for Liver Transplantation in Fulminant Hepatic Failure

In acetaminophen-induced fulminant hepatic failure, survival correlated with arterial blood pH, peak prothrombin time, and serum creatinine–a pH less than 7.30, prothrombin time greater than 100 s, and creatinine greater than 300 mumol/L indicating a poor prognosis.

Acetaminophen-induced disease

Arterial pH <7.3 (irrespective of the grade of encephalopathy)


  • Grade III or IV encephalopathy, and
  • Prothrombin time >100 seconds, and
  • Serum creatinine >3.4mg/dl (301 µmol/L)

All other causes of fulminant hepatic failure

Prothrombin time >100 seconds (irrespective of the grade of encephalopathy)


Any three of the following variables (irrespective of the grade of encephalopathy)

  1. Age <10 years or >40 years

  2. Etiology: non-A, non-B hepatitis, halothane hepatitis, idiosyncratic drug reactions

  3. Duration of jaundice before onset of encephalopathy >7 days

  4. Prothrombin time >50 seconds

  5. Serum bilirrubin >18 mg/dl (308 µmol/L)



  1. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989 Aug;97(2):439-45. [Medline]


Created: Jan 29, 2008

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