Unifying Concepts

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

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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