Fracaso hepático agudo, criterios indicación de trasplante

FHA: Indicadores pronósticos y de trasplante hepático

  Indicador Etiología Criterios de trasplante
King's College Paracetamol
 
pH < 7.3(Arterial) o
Todos los siguientes:
  • Creatinina > 3.4 mg/dl
  • TP>100s. (INR >6.5)
  • EH grado III-IV
  • No Paracetamol TP>100s. (INR >6.5) o
    Tres de los siguientes:
  • Etiologia NoA/NoB/Drogas/halotano
  • Ictericia > de 7 días antes de EH
  • Edad < 10 o >40
  • TP>50s. (INR >3.5)
  • Br >17.4 mg/dl (308 μMl/L)
  • Factor V Viral Edad < 30 años : FcV < 20%
    Cualquier edad: FcV<30% + EH III-IV
    Cociente FcVII/V Paracetamol  >30
    Biopsia hepática variada  Necrosis hepatocito > 70%
    Indice de severidad NANB,VHB  Sin referencias
    Fosfato arterial Paracetamol  >1.2 mmol/L
    Lactato arterial Paracetamol  >3.5 mmol/L
    Amonio arterial Variada  >150-200 μMl/L
    APACHE II Paracetamol  Score > 15
    MELD/ΔMELD Paracetamol  MELD>33, ΔMELD>-0.4

    Referencias

    1. O’Grady JG, Alexander GJ, Hayllar KM, et al: Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97:439–445
    2. Bernuau J, Goudeau A, Poynard T, et al: Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology 1986; 6:648–651
    3. Bernuau J, Samuel D, Durand F, et al: Criteria for emergency liver transplantation in patients with acute viral hepatitis and factor V below 50% of normal: A prospective study. Abstr. Hepatology 1991; 14:49A
    4. Pereira LM, Langley PG, Hayllar KM, et al: Coagulation factor V and VIII/V ratio as predictors of outcome in paracetamol-induced fulminant hepatic failure: Relation to other prognostic indicators. Gut 1992; 33:98–102
    5. Donaldson BW, Gopinath R, Wanless IR, et al: The role of transjugular liver biopsy in fulminant liver failure: Relation to other prognostic indicators. Hepatology 1993; 18:1370–1376
    6.  Takahashi Y, Kumada H, Shimizu M, et al: A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation. Hepatology 1994; 19:1065–1071
    7. Schmidt LE, Dalhoff K: Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. Hepatology 2002; 36:659–665 Bernal W, Donaldson N, Wyncoll D, et al: Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: A cohort study. Lancet 2002; 359:558–563
    8. Clemmesen JO, Larsen FS, Kondrup J, et al: Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology 1999; 29:648–653
    9.  Mitchell I, Bihari D, Chang R, et al: Earlier identification of patients at risk from acetaminophen-induced acute liver failure. Crit Care Med 1998; 26:279–284
    10. Schmidt LE, Larsen FS: MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury. Hepatology 2007; 45:789–79