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Acute Liver Failure Transplant — RACP Adult Medicine MCQ

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HardGastroenterologyAcute Liver Failure TransplantRACP Adult Medicine

A 35-year-old woman presents with acute liver failure (encephalopathy + coagulopathy within 26 weeks of liver disease onset). She has no prior liver disease. Paracetamol level is undetectable. Hepatitis serology and autoimmune markers are all negative. She meets King's College Criteria for non-paracetamol ALF (pH <7.3, INR >6.5, creatinine >300). What is the most appropriate management?

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Correct answer: C — Refer for liver transplant assessment

Acute liver failure meeting King's College Criteria (non-paracetamol: pH <7.3 OR INR >6.5 + creatinine >300 + Grade III-IV encephalopathy) has >90% mortality without transplant. Urgent (super-urgent) liver transplant listing is indicated. This is the only scenario where patients bypass the standard waiting list. Aetiology workup should continue in parallel but should not delay listing.

Reference: TSANZ – 2024 – Liver Transplant; EASL 2024 ALF