Indications for liver transplantation
If the acute management of paracetamol poisoning is ineffective and fulminant hepatic necrosis ensues then liver transplantation is life-saving.
The indications for liver transplantation are:
- acidosis (pH < 7.3), or
- all of the following:
- PT > 100 sec
- creatinine > 300 mcg/l
- grade 3 encephalopathy (or worse)
It is better to contact the local liver transplant centre earlier than this. Grossly abnormal prothrombin times should trigger referral:
- PT > 20 sec at 24 hr
- PT > 40 sec at 48 hr
- if PT is between 20 and 40 sec at 48 hr then check the PT again at 72 hr; if PT is still > 20 sec then refer
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