Acute Liver Failure
INR ≥1.5 + encephalopathy, no prior liver disease, <26 weeks
All Pathways
Hepatobiliary SurgeryDiagnostic
Acute Liver Failure - Transplant Criteria (King's College)
Acute Liver Failure - Transplant Criteria (King's College): Acute Liver Failure → Initial Management → Etiology → Acetaminophen ALF → APAP - King's Crit...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Initial Management
ICU admission, supportive care
- NAC if acetaminophen suspected
- ICP monitoring if grade 3-4 HE
- Coagulopathy management
- Etiology workup
03Decision Etiology
- Acetaminophen (APAP)
- Non-Acetaminophen (viral, autoimmune, drug, etc.)
04Action Acetaminophen ALF
King's APAP criteria
05Decision APAP - King's Criteria
- pH <7.30 after resuscitation
- OR all 3: INR >6.5, Cr >3.4, Grade 3-4 HE
06Action Meets Transplant Criteria
List for emergency transplant
- UNOS Status 1A listing
- Evaluate for contraindications
- Bridge therapies if needed
07Action Liver Transplant
When organ available
08End Outcome
Post-transplant care or recovery management
09Action Does Not Meet Criteria
Continue supportive care, reassess
- Serial labs q6-12h
- May still need transplant if deteriorates
- Some recover spontaneously
10Action Spontaneous Recovery
Monitor for complications
- Path rejoins step 08Shared downstream outcome
- Path rejoins step 06Shared downstream outcome
11Action Non-Acetaminophen ALF
King's non-APAP criteria
12Decision Non-APAP - King's Criteria
- INR >6.5 regardless of HE grade
- OR 3 of 5: Age <10 or >40, non-A/non-B hepatitis, drug toxicity, jaundice >7d before HE, INR >3.5, Bili >17.5
- Path rejoins step 06Shared downstream outcome
- Path rejoins step 09Shared downstream outcome
Guideline Source
AASLD Position Paper: Management of Acute Liver Failure
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- King's criteria developed for acetaminophen - may differ for other etiologies
- Some patients recover without transplant despite meeting criteria
- Transplant availability affects utility
- MELD may complement but not replace King's
Applicable Regions
USAUUKEU
EU: EASL acute liver failure guidelines
UK: King's College original criteria
US: AASLD guidelines, UNOS listing
Version 1Next review: 2028-01-01
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Related Resources
Frequently Asked Questions
What is the Acute Liver Failure - Transplant Criteria (King's College)?
The Acute Liver Failure - Transplant Criteria (King's College) is a diagnostic clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on AASLD Position Paper: Management of Acute Liver Failure.
What guideline is the Acute Liver Failure - Transplant Criteria (King's College) based on?
This algorithm is based on AASLD Position Paper: Management of Acute Liver Failure (DOI: 10.1002/hep.31238).
What are the limitations of the Acute Liver Failure - Transplant Criteria (King's College)?
Known limitations include: King's criteria developed for acetaminophen - may differ for other etiologies; Some patients recover without transplant despite meeting criteria; Transplant availability affects utility; MELD may complement but not replace King's. Individual patient factors may require deviation from these recommendations.
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