ICU · Gastroenterology
Acute liver failure: King's College criteria, transplant, and liver support
Also known as Acute liver failure · ALF · Fulminant hepatic failure · King's College Criteria · Liver transplant criteria · MARS therapy
Exam-focused guide to acute liver failure in intensive care: definition and classification, causes, the King's College Criteria and other transplant criteria, N-acetylcysteine, cerebral oedema, coagulopathy, organ support, transplant and liver-support devices.
Checked against its sources on 23 Oct 2026
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Red flags
- Any alteration in mental status, INR >1.5, hypoglycaemia or metabolic acidosis: transfer to a liver transplant centre is highly recommended
- Paracetamol ALF with arterial pH <7.3 after adequate intravenous volume resuscitation: consider emergency liver transplantation
- N-acetylcysteine in all paracetamol overdose and in non-paracetamol ALF with grade 1 or 2 hepatic encephalopathy
- Hypoglycaemia is frequent in ALF and associated with increased mortality: monitor glycaemia every 6 h
Meet the patient
A 24-year-old woman arrives 50 hours after a staggered paracetamol overdose, drowsy and jaundiced with asterixis. After fluid resuscitation her arterial pH is 7.18, INR 7.9, creatinine 314 micromol/L and glucose 2.6 mmol/L. N-acetylcysteine is running. The question for the next hour is whether she meets the criteria for emergency liver transplantation.[6]
References16ShowHide
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