Identification of patients unlikely to survive without transplantation

• Prothrombin time >100s

Or any three of the following:

• Aetiology is hepatitis C, halothane, or other drug reaction

• Duration of jaundice pre-encephalopathy >2 days

• Prothrombin time >50s

• Serum bilirubin >225pmol/l If paracetamol-induced:

• pH <7.3 or prothrombin time >100s and creatinine >200pmol/l plus Grade 3 or 4 encephalopathy.

As only 50-85% of patients identified as requiring transplantation will survive long enough to receive one, the Regional Liver Unit should be informed soon after diagnosis of all possible candidates.

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