🫀 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.
Meeting the criteria should prompt immediate contact with a transplant center, as the window for listing is short (original synthesis · not guideline verbatim).
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
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.
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 <10 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：—
Frequently asked questions
- What is 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.
- How is King's College Criteria (Acute Liver Failure Transplant Indication) calculated? What is the core formula?
- 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).
- When is King's College Criteria (Acute Liver Failure Transplant Indication) used?
- Select the etiology (acetaminophen vs non-acetaminophen) and enter the relevant labs and clinical features; the tool reports whether transplant criteria are met.
- What are the key clinical points for King's College Criteria (Acute Liver Failure Transplant Indication)?
- 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.
- 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.
- 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 <10 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: —）