🫀 King's College Criteria (Acute Liver Failure Transplant Indication)
UseSelect the etiology (acetaminophen vs non-acetaminophen) and enter the relevant labs and clinical features; t…
SourceEuropean Association for the Study of the Liver. EASL Clinical Practical Guidelines on the manageme…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Arterial lactate and phosphate refine the acetaminophen prognosis and are used by some centers alongside the classic pH threshold.
When to use
Select the etiology (acetaminophen vs non-acetaminophen) and enter the relevant labs and clinical features; the tool reports whether transplant criteria are met.
How it works
Acetaminophen: pH <7.30 after resuscitation, OR all of (INR >6.5, creatinine >300 μmol/L, grade III/IV encephalopathy). Non-acetaminophen: INR >6.5 alone, OR ≥3 of (age <11 or >40, unfavorable etiology, jaundice >7 days before encephalopathy, INR >3.5, bilirubin >300 μmol/L).
Key points
- Arterial lactate and phosphate refine the acetaminophen prognosis and are used by some centers alongside the classic pH threshold.
- Not meeting the criteria does not exclude deterioration—reassess pH, INR, creatinine, and encephalopathy grade dynamically.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Etiology | Acetaminophen (paracetamol) |
|---|---|
| [APAP] Arterial pH after resuscitation | 7.30 |
| INR | 6.5 |
| [APAP] Serum creatinine | 300 μmol/L |
| [APAP] Grade III/IV hepatic encephalopathy | Yes |
| [Non-APAP] Bilirubin | 300 μmol/L |
| [Non-APAP] Age <11 or >40 | Yes |
| [Non-APAP] Unfavorable etiology (non-A non-B hepatitis/halothane/idiosyncratic drug) | Yes |
| [Non-APAP] Jaundice >7 days before encephalopathy | Yes |
→Transplant indicationDoes not meet
- pH<7.30 (post-resuscitation)：—
- INR>6.5 and Scr>300 and grade III/IV enceph：—
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using King's College Criteria (Acute Liver Failure Transplant Indication)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does King's College Criteria (Acute Liver Failure Transplant Indication) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is King's College Criteria (Acute Liver Failure Transplant Indication) calculated in practice? Can you show a worked example?
- Inputs: Etiology Acetaminophen (paracetamol), [APAP] Arterial pH after resuscitation 7.30, INR 6.5, [APAP] Serum creatinine 300 μmol/L, [APAP] Grade III/IV hepatic encephalopathy Yes, [Non-APAP] Bilirubin 300 μmol/L, [Non-APAP] Age <11 or >40 Yes, [Non-APAP] Unfavorable etiology (non-A non-B hepatitis/halothane/idiosyncratic drug) Yes… → Result: Transplant indication Does not meet（pH<7.30 (post-resuscitation): —, INR>6.5 and Scr>300 and grade III/IV enceph: —）