{ "schemaVersion": 2, "eyebrow": "Hepatology and Critical Care", "title": "Acute Liver Failure Transfer Criteria", "summary": "Transfer patients with acute liver failure immediately to a liver transplant center when INR is at least 1.5 with encephalopathy, or when severe acute liver injury is rapidly progressing toward these features.", "seoDescription": "Physician criteria for urgent transfer of acute liver failure to a transplant center, including encephalopathy, INR elevation, ICU escalation, and prognostic urgency.", "clinicalQuestion": "Which patients with acute liver injury require immediate transfer to a liver transplant center?", "specialty": "Hepatology", "audience": "U.S. physicians and medical trainees", "tags": [ "acute liver failure", "liver transplant referral", "acute liver injury", "hepatic encephalopathy", "INR 1.5", "critical care hepatology" ], "keyTakeaways": [ "Treat acute liver failure as a transfer emergency: acute hepatocellular injury with INR at least 1.5 and any hepatic encephalopathy warrants urgent management at a transplant-capable center. [13][14]", "Do not wait for advanced encephalopathy or a prognostic score to initiate transfer discussions; emergency transplantation is the definitive treatment when liver regeneration does not occur. [5][16][18]", "Escalate severe acute liver injury before encephalopathy develops when coagulopathy, worsening neurologic status, hyperammonemia, or multiorgan dysfunction suggests imminent acute liver failure. [4][5][22]", "Acetaminophen ingestion requires immediate acetaminophen measurement at 4 hours or later after ingestion and prompt N-acetylcysteine; transfer decisions should proceed in parallel with antidotal therapy. [2]", "Acute liver failure is distinct from acute-on-chronic liver failure: pre-existing cirrhosis, decompensation, and extrahepatic organ failures require a different prognostic and transplant-assessment framework. [5][20]" ], "sections": [ { "id": "who-needs-immediate-transfer", "eyebrow": "Core Decision", "heading": "Transfer immediately when acute liver failure is established", "intro": "The transfer threshold is syndromic, not aminotransferase-based.", "paragraphs": [ "Arrange immediate transfer to a liver transplant center for a patient without established chronic liver disease who has acute hepatocellular injury, an INR of at least 1.5, and hepatic encephalopathy. This combination defines acute liver failure and identifies patients at risk for rapidly progressive cerebral edema, intracranial hypertension, multiorgan failure, or death without hepatic recovery or emergency transplantation. [5][13][14]", "Call the receiving transplant center as soon as encephalopathy is recognized rather than waiting for deep coma, a completed etiologic workup, or fulfillment of prognostic criteria. Liver transplantation is the definitive treatment for acute liver failure when regeneration does not occur, and prognostic assessment is most useful when performed early enough to preserve transplant opportunity. [5][16][18]", "Use the highest level of transport and destination capability compatible with the patient's trajectory. Patients with worsening mental status, hemodynamic instability, respiratory compromise, renal failure, or concern for cerebral edema require ICU-to-ICU transfer with airway and hemodynamic support available during transport. Acute liver failure management differs from cirrhosis-associated encephalopathy because rapidly developing hyperammonemia can cause cerebral edema and intracranial hypertension. [5][15][22]" ], "bullets": [ "Established acute liver failure: acute injury plus INR at least 1.5 plus encephalopathy in a patient usually without pre-existing chronic liver disease—transfer immediately. [5][13][14]", "Progressive neurologic dysfunction in acute liver injury: move to ICU-level care and activate transplant-center consultation while evaluating alternative causes of altered mental status. [5]", "Hyperammonemia with concern for cerebral edema or intracranial hypertension: transfer to a center able to provide neuroprotective ICU care, continuous renal replacement therapy, therapeutic plasma exchange, and emergency transplantation. [5]" ], "subsections": [], "table": { "caption": "Transfer urgency is determined by acute liver failure features and trajectory, rather than aminotransferase magnitude alone. [5][13][14]", "columns": [ "Clinical state", "Interpretation", "Disposition" ], "rows": [ [ "Acute liver injury with INR ≥1.5 and hepatic encephalopathy", "Meets acute liver failure definition. [13][14]", "Immediate transplant-center transfer and ICU-level management. [5][16]" ], [ "Severe acute liver injury with evolving coagulopathy or neurologic change but no established encephalopathy", "May progress quickly to acute liver failure. [4][22]", "Urgent transplant-center consultation; transfer before deterioration if progression is evident. [4][16]" ], [ "Acute-on-chronic liver failure or decompensated cirrhosis with encephalopathy", "Different syndrome; organ-failure burden drives prognosis and ICU needs. [5][20]", "Manage in a center experienced with advanced liver disease; assess transplant candidacy according to the chronic liver disease context. [5][20]" ] ] } }, { "id": "transfer-before-encephalopathy", "eyebrow": "Pre-ALF Escalation", "heading": "Transfer severe acute liver injury before encephalopathy when deterioration is likely", "intro": "Encephalopathy should not be the first trigger for transplant-center contact.", "paragraphs": [ "Patients with severe acute liver injury should undergo serial assessment of INR and neurologic status because progression to INR at least 1.5 with encephalopathy changes the diagnosis to acute liver failure and requires emergency transfer. A rising INR or new confusion, asterixis, somnolence, or impaired arousal should trigger same-day discussion with a transplant center even while repeat testing and etiologic evaluation continue. [13][14][22]", "Treat worsening hepatic encephalopathy as a time-sensitive escalation marker. In acute liver failure, hyperammonemia may culminate in cerebral edema and intracranial hypertension; centers with advanced liver ICU capability can provide neuroprotective monitoring, osmotic therapy for intracranial-pressure surges, continuous renal replacement therapy, therapeutic plasma exchange, and emergency transplantation. [5][15]", "Use etiology to lower the threshold for early transfer, not to delay it. Acetaminophen-related acute liver failure, hepatitis A-associated acute liver failure, and ischemic liver injury have reported transplant-free survival above 60% in one multicenter experience, whereas idiosyncratic drug reactions, hepatitis B, Budd-Chiari syndrome, autoimmune hepatitis, and indeterminate acute liver failure had reported transplant-free survival of only 15% to 20%. These outcome differences support early transplant-center involvement for etiologies with lower expected spontaneous recovery. [18]" ], "bullets": [ "Repeat INR and formal neurologic assessment frequently enough to detect transition from severe injury to acute liver failure; an INR threshold of 1.5 with encephalopathy is decisive. [13][14]", "Escalate immediately for declining consciousness or other evidence of progressive encephalopathy because neurologic deterioration may signal cerebral edema risk in acute liver failure. [5][15]", "Early transplant-center contact is particularly important for suspected idiosyncratic drug-induced injury, hepatitis B, Budd-Chiari syndrome, autoimmune hepatitis, or indeterminate acute liver failure. [18]" ], "subsections": [], "table": { "caption": "Etiology informs urgency because transplant-free survival differs substantially across acute liver failure causes. [18]", "columns": [ "Etiologic pattern", "Reported transplant-free survival pattern", "Transfer implication" ], "rows": [ [ "Acetaminophen, hepatitis A, or ischemic liver injury", "More than 60% transplant-free survival in a cited U.S. multicenter series. [18]", "Continue aggressive cause-directed and ICU care, but transfer established acute liver failure immediately. [5][18]" ], [ "Idiosyncratic drug reaction, hepatitis B, Budd-Chiari syndrome, autoimmune hepatitis, or indeterminate cause", "Approximately 15% to 20% transplant-free survival in that series. [18]", "Initiate transplant-center consultation early and do not await advanced encephalopathy. [16][18]" ] ] } }, { "id": "stabilize-during-transfer", "eyebrow": "Before Departure", "heading": "Stabilize and treat reversible causes without delaying transfer", "intro": "Start time-sensitive measures at the referring hospital and continue them during transfer.", "paragraphs": [ "For known or suspected acetaminophen ingestion, obtain a serum acetaminophen concentration immediately when presentation is at least 4 hours after ingestion; concentrations obtained earlier than 4 hours may be misleading. If ingestion occurred within a few hours of presentation, administer activated charcoal immediately before N-acetylcysteine to reduce systemic absorption. Do not delay N-acetylcysteine or transfer planning while awaiting transfer logistics. [2]", "Acetaminophen-associated injury can progress to acute liver failure despite initially incomplete history or low perceived risk. Acetaminophen doses exceeding 4,000 mg/day, particularly use of multiple acetaminophen-containing products, are associated with acute liver failure; risk is higher with underlying liver disease or alcohol ingestion. Obtain a complete medication reconciliation that includes prescription analgesics, over-the-counter cold products, and combination opioids. [2]", "For non-acetaminophen acute liver failure, consider intravenous acetylcysteine during early-stage disease because it improves transplant-free survival in early non-acetaminophen acute liver failure. This is adjunctive treatment and does not replace transfer, ICU monitoring, or transplant assessment. [4][16]", "If encephalopathy is present, prioritize airway protection, serial neurologic assessment, and transfer to an ICU environment capable of detecting and treating cerebral edema. Continuous renal replacement therapy and therapeutic plasma exchange are described ammonia-lowering approaches in acute liver failure; their availability is a practical reason to transfer early rather than attempt prolonged management in a nontransplant setting. [5]" ], "bullets": [ "Suspected acetaminophen exposure: obtain a serum level at presentation if at least 4 hours have elapsed; do not interpret a level drawn before 4 hours as definitive. [2]", "Presentation within a few hours of acetaminophen ingestion: give activated charcoal just before N-acetylcysteine. [2]", "Early non-acetaminophen acute liver failure: use acetylcysteine as a transplant-free-survival intervention while arranging definitive care. [4]", "Encephalopathy with suspected cerebral edema: avoid transport to a facility unable to deliver advanced liver ICU and transplant services. [5]" ], "subsections": [], "table": { "caption": "Actions at the referring hospital should run in parallel with transplant-center transfer. [2][4][5]", "columns": [ "Problem", "Immediate action", "What it changes" ], "rows": [ [ "Suspected acetaminophen ingestion ≥4 hours earlier", "Obtain serum acetaminophen concentration immediately. [2]", "Assesses hepatotoxicity risk; transfer decisions remain based on clinical severity and trajectory. [2][13]" ], [ "Suspected acetaminophen ingestion within a few hours", "Administer activated charcoal just before N-acetylcysteine. [2]", "Reduces systemic absorption while antidotal treatment and transfer proceed. [2]" ], [ "Early-stage non-acetaminophen acute liver failure", "Initiate acetylcysteine. [4]", "May improve transplant-free survival; does not remove need for transplant evaluation. [4][16]" ], [ "Hyperammonemia with worsening encephalopathy", "Transfer for neuroprotective ICU care; consider center-based continuous renal replacement therapy or therapeutic plasma exchange. [5]", "Addresses risk of cerebral edema and intracranial hypertension. [5][15]" ] ] } }, { "id": "transplant-assessment", "eyebrow": "Destination Planning", "heading": "Use prognostic tools to support listing decisions, not to postpone transfer", "intro": "Emergency transplant assessment should begin upon recognition of acute liver failure.", "paragraphs": [ "At the transplant center, assess likelihood of spontaneous recovery repeatedly rather than relying on a single laboratory value. King’s College criteria, lactate after fluid resuscitation in acetaminophen-related acute liver failure, MELD-based approaches, and dynamic models are used for prognosis, but prognostic criteria are imperfect—particularly for identifying patients who will survive without transplantation. [17][18][19]", "A post-resuscitation serum lactate can add prognostic information in acetaminophen-induced acute liver failure. Its clinical role is to strengthen risk assessment alongside established criteria after adequate fluid resuscitation, not to provide a stand-alone reason to withhold transfer from a patient with established acute liver failure. [18]", "Early referral protects the window for high-urgency listing and transplantation. In adults with acute liver failure, overall 21-day survival improved from 67.1% to 75.3% across two 8-year eras, while transplant-free survival improved from 45.1% to 56.2%, reflecting advances in critical care and transplantation but not eliminating the need for rapid specialty transfer. [9][16]" ], "bullets": [ "Obtain prognostic testing after transfer as a serial assessment; do not use failure to meet one score as a reason to retain an acute liver failure patient locally. [17][18][19]", "In acetaminophen-associated acute liver failure, interpret lactate after fluid resuscitation as an adjunct to established prognostic assessment. [18]", "Reassess for liver regeneration versus need for emergency transplantation throughout ICU care. [5][16]" ], "subsections": [ { "heading": "When not to classify the presentation as classic acute liver failure", "paragraphs": [ "Patients with known cirrhosis and encephalopathy generally have decompensated cirrhosis or acute-on-chronic liver failure rather than classic acute liver failure. In acute-on-chronic liver failure, the presence and number of organ failures drive prognosis, and global organ-dysfunction models such as SOFA, CLIF-SOFA, and APACHE II may outperform liver-specific scores. [5][20]" ], "bullets": [ "Do not apply classic acute liver failure transfer language uncritically to chronic cirrhosis; identify acute-on-chronic liver failure and quantify extrahepatic organ dysfunction. [5][20]" ] } ], "table": { "caption": "Prognostic assessment supports emergency transplant decisions after transfer; it should not create a barrier to early referral. [16][17][18][19]", "columns": [ "Assessment approach", "Best-supported use in this evidence set", "Limitation affecting transfer decisions" ], "rows": [ [ "King’s College criteria", "Established prognostic framework for acute liver failure and transplant selection. [17][18][19]", "Can identify high-risk patients but is less reliable for predicting survival in those who do not fulfill criteria. [18]" ], [ "Lactate after fluid resuscitation", "Adds prognostic value in acetaminophen-induced acute liver failure. [18]", "Adjunctive marker; requires interpretation with the overall clinical course. [18]" ], [ "MELD and dynamic prediction models", "Alternative or complementary prognostic approaches under evaluation in acute liver failure. [17][19]", "No single model replaces early transplant-center assessment. [16][18]" ], [ "SOFA, CLIF-SOFA, APACHE II", "Useful in acute-on-chronic liver failure because global organ dysfunction is prognostically important. [20]", "Apply within the chronic liver disease context rather than as classic acute liver failure criteria. [20]" ] ] } }, { "id": "practical-transfer-order", "eyebrow": "Operational Checklist", "heading": "A practical referral sequence for the referring clinician", "intro": "Perform these actions concurrently; sequential completion risks avoidable delay.", "paragraphs": [ "First, confirm whether the patient has acute liver failure: acute liver injury, INR at least 1.5, and encephalopathy in the absence of established chronic liver disease. If present, contact a liver transplant center immediately and request ICU acceptance. [13][14][16]", "Second, document the trajectory for the accepting team: timing of symptom onset, change in mental status, serial INR values, suspected acetaminophen exposure and level timing, medication and toxin exposures, alcohol use, pregnancy status, and known chronic liver disease. Etiologic distinction matters because outcome and transplant-free survival differ across acetaminophen, viral, ischemic, drug-induced, autoimmune, vascular, and indeterminate presentations. [2][10][18]", "Third, treat immediately actionable causes while transport is arranged. For suspected acetaminophen exposure, obtain the appropriately timed level, give activated charcoal when presentation is within a few hours, and begin N-acetylcysteine. For early non-acetaminophen acute liver failure, consider acetylcysteine. [2][4]", "Fourth, communicate neurologic and organ-support needs before departure. New or progressive encephalopathy, hyperammonemia-related concern for cerebral edema, renal support needs, or hemodynamic instability should prompt transfer directly to a liver ICU/transplant center rather than an intermediate ward-level destination. [5][15][22]" ], "bullets": [ "Immediate call: established acute liver failure by INR ≥1.5 plus encephalopathy. [13][14]", "Parallel treatment: acetaminophen concentration when appropriately timed, activated charcoal when early after ingestion, and N-acetylcysteine. [2]", "Parallel escalation: ICU transport planning for neurologic decline, renal failure, or suspected cerebral edema. [5][22]", "Receiving-team handoff: serial INR and mental-status trajectory, etiology assessment, exposure history, and treatments already started. [2][18]" ], "subsections": [], "table": { "caption": "Concurrent referral steps reduce delay between recognition of acute liver failure and transplant-center care. [2][5][13][16]", "columns": [ "Time point", "Required action", "Escalation trigger" ], "rows": [ [ "At recognition", "Identify INR ≥1.5 with encephalopathy and call a transplant center. [13][14][16]", "Any established acute liver failure. [13][14]" ], [ "During initial stabilization", "Obtain appropriately timed acetaminophen level and start indicated exposure-directed measures. [2]", "Known or suspected acetaminophen ingestion. [2]" ], [ "Before transport", "Provide ICU-level neurologic and organ-support planning. [5][22]", "Worsening encephalopathy, hyperammonemia concern, renal failure, or instability. [5][15]" ], [ "After arrival", "Perform serial prognostic assessment and emergency transplant evaluation. [16][17][18]", "Failure of hepatic recovery or worsening multiorgan dysfunction. [5][16]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Guidance for Industry: Drug-Induced Liver Injury", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/116737/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 2, "title": "ACETAMINOPHEN AND CODEINE PHOSPHATE TABLETS, USP300 mg/30 mg and 300 mg/60 mg", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1afe1bb3-6903-4785-a121-ac8aae8653a7&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 3, "title": "Hepatic encephalopathy: Part 2, inpatient management", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/flgastro/17/4/345.full.pdf", "authors": "fg.bmj.com", "host": "fg.bmj.com" }, { "number": 4, "title": "How to manage: acute liver failure - Frontline Gastroenterology", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/flgastro/11/1/70.full.pdf", "authors": "fg.bmj.com", "host": "fg.bmj.com" }, { "number": 5, "title": "Hepatic encephalopathy: Part 2, inpatient management | Frontline Gastroenterology", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/17/4/345", "authors": "fg.bmj.com", "host": "fg.bmj.com" }, { "number": 6, "title": "Macrophage Therapy for Acute Liver Injury (MAIL): a study protocol ...", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/14/12/e089417", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com" }, { "number": 7, "title": "An Open-label Phase 1 Study to Assess the Safety, Tolerability ...", "detail": "jitc.bmj.com", "url": "https://jitc.bmj.com/content/jitc/suppl/2024/11/24/jitc-2024-009336.DC1/jitc-2024-009336supp002_data_supplement.pdf", "authors": "jitc.bmj.com", "host": "jitc.bmj.com" }, { "number": 8, "title": "Acute liver failure", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60274-7/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 9, "title": "Outcomes in Adults With Acute Liver Failure Between 1998 and 2013", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/M15-2211", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 10, "title": "FIGO guideline on liver disease and pregnancy - Nana - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online Library", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.70161?af=R", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com" }, { "number": 11, "title": "Indeterminate pediatric acute liver failure: Clinical characteristics of ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ueg2.12269", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 12, "title": "North American Society for Pediatric Gastroenterology, Hepatology ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1097/MPG.0000000000003268", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 13, "title": "Managing the patient with acute liver failure - Clinical Liver Disease", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/cld.628", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 14, "title": "Acute Liver Failure (ALF) in Pregnancy - Deep Blue Repositories", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1002/hep.31144", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 15, "title": "Liver intensive care for the general intensivist", "detail": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "url": "https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.15956", "authors": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "host": "associationofanaesthetists-publications.onlinelibrary.wiley.com" }, { "number": 16, "title": "Liver Transplantation for Acute Liver Failure- Indication, Prioritization, Timing, and Referral - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0973688323000087", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 17, "title": "Prognostic models in acute liver failure-historic evolution and newer updates “prognostic models in acute liver failure” - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1521691824000829", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 18, "title": "How to decide when to list a patient with acute liver failure for liver transplantation? 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Guidance for Industry: Drug-Induced Liver Injury", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/116737/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "One of the subjects in the Diabetes Prevention Trial with ALT >30xULN developed liver failure and died, despite receiving a liver transplant. The 23 Contains Nonbinding Recommendations second subject recovered. 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The often rapid development of hyperammonaemia in ALF may culminate in cerebral oedema and intracranial hypertension, ", "score": 0.4902606 }, { "number": 6, "title": "Macrophage Therapy for Acute Liver Injury (MAIL): a study protocol ...", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/14/12/e089417", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com", "snippet": "Acute liver failure (ALF) has no effective treatment other than liver transplantation and is commonly caused by paracetamol overdose.", "score": 0.28817877 }, { "number": 7, "title": "An Open-label Phase 1 Study to Assess the Safety, Tolerability ...", "detail": "jitc.bmj.com", "url": "https://jitc.bmj.com/content/jitc/suppl/2024/11/24/jitc-2024-009336.DC1/jitc-2024-009336supp002_data_supplement.pdf", "authors": "jitc.bmj.com", "host": "jitc.bmj.com", "snippet": "Grade 3 (DLT exceptions): MEDI5395 dosing should be held until the toxicity resolves to Grade 1 or baseline. If resolution occurs within the 18-day MEDI5395 treatment period, then the investigator may consider continued dosing of MEDI5395; otherwise permanently discontinue study treatment.\nGrade 4 (", "score": 0.08531997 }, { "number": 8, "title": "Acute liver failure", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60274-7/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "# Acute liver failure - The Lancet. # Acute liver failure. **Fulminant hepatic failure: outcome after listing for highly urgent liver transplantation—12 years experience in the nordic countries**. Escorsell, A ∙ Mas, A ∙ de la Mata, M, the Spanish Group for the Study of Acute Liver Failure. **Etiolo", "score": 0.5437604 }, { "number": 9, "title": "Outcomes in Adults With Acute Liver Failure Between 1998 and 2013", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/M15-2211", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "The 21-day survival rates increased between the two 8-year periods (overall, 67.1% vs. 75.3%; transplant-free survival [TFS], 45.1% vs. 56.2%;", "score": 0.37463108 }, { "number": 10, "title": "FIGO guideline on liver disease and pregnancy - Nana - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online Library", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.70161?af=R", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "The immediate past and present chairs of FIGO's Committee on the Impact of Pregnancy on Long-term Health invited the Chair of the European guideline, alongside two trainees with an interest in liver disorders in pregnancy, to develop a guideline relevant to a global audience, thus serving the real-w", "score": 0.97678 }, { "number": 11, "title": "Indeterminate pediatric acute liver failure: Clinical characteristics of ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ueg2.12269", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Her ALT level was 3600 IU/L and bilirubin 83 μmol/L, with normal INR and ammonia level. ... Hepatic encephalopathy was briefly assessed at", "score": 0.51691306 }, { "number": 12, "title": "North American Society for Pediatric Gastroenterology, Hepatology ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1097/MPG.0000000000003268", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Screening for Wilson disease in acute liver failure: a comparison of currently available diagnostic tests. Analysis of viral testing in nonacetaminophen", "score": 0.50476116 }, { "number": 13, "title": "Managing the patient with acute liver failure - Clinical Liver Disease", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/cld.628", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "ALF definition has evolved and currently includes the following features: international normalized ratio (INR) ≥ 1.5, neurological dysfunction", "score": 0.47913864 }, { "number": 14, "title": "Acute Liver Failure (ALF) in Pregnancy - Deep Blue Repositories", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1002/hep.31144", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Acute liver failure (ALF), characterized by sudden onset of coagulopathy (international normalized ratio [INR] ≥ 1.5) and encephalopathy, may occur during", "score": 0.4511578 }, { "number": 15, "title": "Liver intensive care for the general intensivist", "detail": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "url": "https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.15956", "authors": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "host": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "snippet": "Ammonia plays a central role in the pathogenesis of hepatic encephalopathy, and initial treatment strategies for hepatic encephalopathy in acute liver failure", "score": 0.44087905 }, { "number": 16, "title": "Liver Transplantation for Acute Liver Failure- Indication, Prioritization, Timing, and Referral - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0973688323000087", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Liver Transplantation for Acute Liver Failure- Indication, Prioritization, Timing, and Referral - ScienceDirect\n# Review Article Liver Transplantation for Acute Liver Failure- Indication, Prioritization, Timing, and Referral. Acute liver failure (ALF) is a major success story in gastroenterol", "score": 0.75377536 }, { "number": 17, "title": "Prognostic models in acute liver failure-historic evolution and newer updates “prognostic models in acute liver failure” - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1521691824000829", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Lancet Gastroenterol Hepatol\n\n### Early indicators of prognosis in fulminant hepatic failure: an assessment of the King's criteria\n\n### J Hepatol\n\n### Acute liverfailure: clinical features, outcome analysis, and applicability of prognostic criteria\n\n### Liver Transpl\n\n### Emergency liver transpl", "score": 0.73207545 }, { "number": 18, "title": "How to decide when to list a patient with acute liver failure for liver transplantation? Clichy or King’s College criteria, or something else? - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0168827807000505", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Forum on Liver Transplantation How to decide when to list a patient with acute liver failure for liver transplantation? Acute liver failure (ALF) is characterized by massive acute injury to a previously healthy liver associated with development of hepatic encephalopathy. Orthotopic liver transplan", "score": 0.70871735 }, { "number": 19, "title": "Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1542356515014032", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Transplant Proc\n\n### MELD score as a prognostic model for listing acute liver failure patients for liver transplantation\n\n### Transplant Proc\n\n### Prognostic implications of lactate, bilirubin, and etiology in German patients with acute liver failure\n\n### Clin Gastroenterol Hepatol\n\n### Cytokera", "score": 0.70799106 }, { "number": 20, "title": "Acute on chronic liver failure: prognostic models and... : Hepatology Communications", "detail": "journals.lww.com", "url": "https://journals.lww.com/hepcomm/fulltext/2023/04010/acute_on_chronic_liver_failure__prognostic_models.15.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: Acute on chronic liver failure: prognostic models and... : Hepatology Communications\n**Abbreviations**: AARC, APASL ACLF Research Consortium; ACLF, acute on chronic liver failure; AD, acute decompensation; AI, artificial intelligence; ANN, artificial neural network; APACHE II, Acute Physiolog", "score": 0.65173227 }, { "number": 21, "title": "FIGO guideline on liver disease and pregnancy", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/ijgo.70161", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "A pre- pregnancy Model for End- stage Liver Disease (MELD) score of <6 predicts a favorable outcome, whereas a MELD score >10 predicts", "score": 0.20596655 }, { "number": 22, "title": "Management of acute liver failure in intensive care", "detail": "www.bjanaesthesia.org", "url": "https://www.bjanaesthesia.org/article/S2058-5349(20)30156-6/fulltext", "authors": "www.bjanaesthesia.org", "host": "www.bjanaesthesia.org", "snippet": "by R Aziz · 2021 · Cited by 21 — Acute liver failure (ALF) is a highly specific liver condition characterised by a rapidly progressive life-threatening illness.Read more", "score": 0.98502 }, { "number": 23, "title": "EASL Clinical Practice Guidelines on nutrition in chronic ...", "detail": "easl.eu", "url": "https://easl.eu/wp-content/uploads/2018/10/EASL-CPG-nutrition-in-chronic-liver-disease.pdf", "authors": "easl.eu", "host": "easl.eu", "snippet": "EASL Clinical Practice Guidelines on nutrition in chronic liver diseaseq European Association for the Study of the Liver* Summary A frequent complication in liver cirrhosis is malnutrition, which is associated with the progression of liver failure, and with a higher rate of complications including i", "score": 0.98388 }, { "number": 24, "title": "[PDF] THE INTERNATIONAL LIVER CONGRESS™ - EASL", "detail": "easl.eu", "url": "https://easl.eu/wp-content/uploads/2021/06/EASL_2021_Version-2-compressed.pdf", "authors": "easl.eu", "host": "easl.eu", "snippet": "Systems level elucidation of the pathophysiology of acute decompensation of cirrhosis at multiple levels (genetic, epigenetic, transcriptomic, metabolomics, lipidomics, miR, and extracellular vesicles) Integration of existing clinical data and new multi-omics data from 2,200 patients with more than ", "score": 0.98205 } ], "publishedAt": "2026-09-15T18:43:30.508600+00:00", "updatedAt": "2026-09-15T18:43:30.508600+00:00", "readingMinutes": 7, "slug": "acute-liver-failure-transfer-criteria" }