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ALF Transplant Listing — RACP Adult Medicine MCQ

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EasyGastroenterologyALF Transplant ListingRACP Adult Medicine

A 25-year-old woman with paracetamol-induced ALF has INR 5.5, pH 7.25 (after resuscitation), creatinine 350 μmol/L, and Grade III hepatic encephalopathy. She meets King's College Criteria for paracetamol ALF. NAC is running. What is the most critical next step?

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Correct answer: D — Urgent liver transplant listing

Meeting King's College Criteria (paracetamol: pH <7.3 after resuscitation, OR all three of: Grade III/IV encephalopathy + INR >6.5 + creatinine >300) predicts >90% mortality without transplant. URGENT super-urgent liver transplant listing is critical — these patients are prioritised on the transplant waiting list. Continue NAC (improves outcomes even in established ALF). ICU management: cerebral oedema monitoring/treatment, haemodynamic support, infection surveillance, glucose monitoring.

Reference: EASL – 2024 – ALF; King's College Criteria; TSANZ 2024