Transplant-free survival in dengue-associated acute liver failure: Current evidence and future directions

Dengue virus infection is one of the most prevalent arboviral diseases worldwide, particularly affecting tropical and subtropical regions, and continues to pose a significant public health burden. Although hepatic involvement is a well-recognized manifestation of dengue infection, ranging from mild transaminase elevation to severe hepatitis, acute liver failure remains an uncommon but devastating complication associated with exceptionally high mortality. In many dengue endemic regions, access to liver transplantation is limited or nonexistent, underscoring the importance of identifying reliable predictors of transplant-free survival to guide timely clinical decision making. In this review, we comprehensively evaluate the existing literature, including observational studies and meta-analyses, to delineate key prognostic determinants and to propose evidence based therapeutic strategies aimed at improving patient outcomes and the survival.