Liver Transplantation for Dengue-induced Acute Liver Failure

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Akila Rajakumar, Prateek Gupta, Ashwin Rammohan, Vidya Devarajan, Dinesh Jothimani, Naresh Shanmugam, Ilankumaran Kaliamoorthy, Mohamed Rela
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Abstract

Although liver involvement has been observed in over two-third cases of dengue viral infection, less than 1% cases progress to dengue-related acute liver failure (D-ALF). Various aspects of management of this disease remain debated including the need and timing of liver transplantation (LT). Moreover, the outcomes of LT for D-ALF have been suboptimal. We present four contrasting cases of D-ALF, two managed with LT and the other two conservatively to highlight the management dilemmas concerning LT in D-ALF. Based on our 4 cases, we would consider dengue shock syndrome, multisystem involvement and neurological deficit not completely accounted for by the ALF as potential contraindications for LT. These would need to be revisited on a case-to-case basis till larger studies define objective selection criteria for LT in D-ALF.

肝移植治疗登革热引发的急性肝衰竭
尽管在超过三分之二的登革热病毒感染病例中观察到肝脏受累,但只有不到1%的病例发展为登革热相关急性肝衰竭(D-ALF)。关于该病的治疗,包括肝移植(LT)的必要性和时机等各方面仍存在争议。此外,LT治疗D-ALF的效果并不理想。我们介绍了四例截然不同的 D-ALF 病例,其中两例接受了 LT 治疗,另外两例则采取保守治疗,以突出 D-ALF 的 LT 治疗难题。根据我们的四例病例,我们认为登革热休克综合征、多系统受累和神经功能缺损(ALF不能完全解释)是LT的潜在禁忌症。在更大规模的研究确定D-ALF中LT的客观选择标准之前,我们需要根据每个病例的具体情况重新审视这些禁忌症。
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来源期刊
Journal of Clinical and Experimental Hepatology
Journal of Clinical and Experimental Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.90
自引率
16.70%
发文量
537
审稿时长
64 days
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