Abstract
Although liver involvement has been observed in over two-thirds of cases of dengue viral infection (DENV), less than 1% 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 DALF. Based on our 4 cases, we would consider dengue shock syndrome (DSS), 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.
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