Review Article

Indications and Contraindications for Liver Transplantation

Table 4

UK blood and transplant criteria for registration as a super-urgent transplant.

Paracetamol poisoning

Category 1pH < 7.25 more than 24 hours after overdose and fluid resuscitation

Category 2Coexisting prothrombin time >100 s or INR > 6.5 and serum creatinine >300 μmol/L or anuria, and grade 3-4 en encephalopathy

Category 3Serum Lactate >24 hours after overdose > 3.5 mmol/L on admission or >3 mmol/L after fluid resuscitation

Category 4Two of the three criteria from category 2 with clinical evidence of deterioration (e.g. increased ICP, Fi02 > 50%, increasing inotrope requirement) in the absence of clinical sepsis

Seronegative hepatitis, hepatitis A, B, or an idiosyncratic drug
reaction

Category 5Prothrombin time >100 s or INR > 6.5, and any grade of encephalopathy

Category 6Any grade of encephalopathy, and any three from the following: unfavourable aetiology (idiosyncratic drug reaction, seronegative hepatitis), age > 40 years jaundice encephalopathy interval >7 days, serum bilirubin >300 μmol/L, prothrombin time >50 s or INR > 3.5

Category 7Acute presentation of Wilson’s disease, or Budd-Chiari syndrome. A combination of coagulopathy, and any grade of encephalopathy

Category 8Hepatic artery thrombosis on days 0 to 21 days after liver transplantation

Category 9Early graft dysfunction on days 0 to 7 after liver transplantation with at least 2 of the following: AST > 10,000 IU/L, INR > 3.0, serum lactate > 3 mmol/L, absence of bile production

Category 10Any patient who has been a live donor who develops severe liver failure within 4 weeks of the donor operation