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ALF – transplant listing — RACP Paediatrics MCQ

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HardGIALF – transplant listingRACP Paediatrics

The child with ALF develops grade III hepatic encephalopathy. INR is 6.5 and rising. Ammonia is markedly elevated. Despite maximal medical support, there is no improvement over 48 hours. What is the most critical decision to make?

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Correct answer: B — Liver transplant listing

When paediatric ALF does not improve with medical management, urgent listing for liver transplantation must be considered. King's College criteria (or modified paediatric criteria) guide this decision. Early contact with a transplant centre is essential as deterioration can be rapid. Transplantation is lifesaving when spontaneous recovery is unlikely.

Reference: RCH Melbourne – 2023 – ALF CPG; RACP Paediatric Curriculum – GI