"improving intensive care in Scotland"

Liver failure

Liver transplant

Liver transplant criteria

Transplants are precious. An attempt is made to determine the patients who will benefit from the procedure.

Some patients would survive without transplantation, and in others the transplant would not provide sufficient additional quality of life to be worthwhile.

Looking after a graft requires commitment from the patient and evidence of previous non-adherence to treatment regimens, or of a chaotic lifestyle, may argue against transplantation as a treatment modality.

Paracetamol induced AHF

  • Encephalopathy and acidosis (pH <7.3) ([H+] > 50) after fluid loading, or

  • Grade III or IV encephalopathy and PT > 100 seconds and creatinine >300 umol l-1

Non-paracetamol induced AHF

  • Any PT > 100 seconds

or three of

    • Age < 10 or > 40 years
    • Cause not hepatitis A or B
    • Jaundice to encephalopathy time more than one week
    • PT > 50 seconds
    • Bilirubin > 300umol l-1

    Contraindications to transplant

    These include:

      • Malignancy
      • ARDS (FiO2 > 0.8)
      • Unresponsive hypotension
      • Untreated infection
      • Severe cardio-respiratory disease
      • Multiple episodes of self harm
      • Alcohol or drug dependence??
      • Consistently expressed wish to die
      • Resistant schizophrenia or dementia

     

    You are now ready for the end of module test.

    Page 7

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