🫀 King's College Criteria (Acute Liver Failure Transplant Indication)
The King's College Criteria identify acute liver failure patients who should be referred for emergency liver transplantation.
King's College Criteria (Acute Liver Failure Transplant Indication)
Etiology
[APAP] Arterial pH after resuscitation
INR
[APAP] Serum creatinine (μmol/L)
[APAP] Grade III/IV hepatic encephalopathy
[Non-APAP] Bilirubin (μmol/L)
[Non-APAP] Age <10 or >40
[Non-APAP] Unfavorable etiology (non-A non-B hepatitis/halothane/idiosyncratic drug)
[Non-APAP] Jaundice >7 days before encephalopathy
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 <10 or >40, unfavorable etiology, jaundice >7 days before encephalopathy, INR >3.5, bilirubin >300 μmol/L).
Key points
- Meeting the criteria should prompt immediate contact with a transplant center, as the window for listing is short (original synthesis · not guideline verbatim).
- 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
- O'Grady JG, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989.
- European Association for the Study of the Liver. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.