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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
King's College criteria and the Clichy-Villejuif criteria require adjustments for assessing acute liver failure due to yellow fever
Bruno da Silva Athanasio, Antonio Marcio de Faria Andrade, Vivian Vasconcelos Costa, Juliano Felix Castro, Silverio Leonardo Macedo Garcia, Mauro Martins Teixeira, Daniele da Gloria Souza, Paula Vieira Teixeira Vidigal, Cristiano Xavier Lima
Bruno da Silva Athanasio, Cristiano Xavier Lima, Department of Surgery, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Antonio Marcio de Faria Andrade, Juliano Felix Castro, Silverio Leonardo Macedo Garcia, Liver Transplantation Unit, Felicio Rocho Hospital, Belo Horizonte 30110-934, Minas Gerais, Brazil
Vivian Vasconcelos Costa, Daniele da Gloria Souza, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
Mauro Martins Teixeira, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
Paula Vieira Teixeira Vidigal, Department of Pathology, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Co-first authors: Bruno da Silva Athanasio and Antonio Marcio de Faria Andrade.
Author contributions: Athanasio BDS and Andrade AMF conducted the study and wrote the paper; Costa VV, Teixeira MM, and Souza DDG provided clinical advice and help writing the actual manuscript; Castro JF and Garcia SLM conducted the study and collect data from clinical cases; Vidigal PVT and Lima CX supervised all phases of the study; all of the authors read and approved the final version of the manuscript to be published.
Supported by The INCT-CNPq Program, No. 465425/2014-3.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Felicio Rocho Hospital, No. 2.851.504.
Informed consent statement: All patients provided informed consent to participate in the study.
Conflict-of-interest statement: All the authors report no conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Cristiano Xavier Lima, MD, PhD, Associate Professor, Department of Surgery, Federal University of Minas Gerais, 190-Bairro Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil.
cxlima@ufmg.br
Received: August 15, 2024
Revised: October 3, 2024
Accepted: November 1, 2024
Published online: March 18, 2025
Processing time: 103 Days and 21.1 Hours
BACKGROUND
Acute liver failure (ALF) is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease. Liver transplantation (LT) is the most impactful treatment. Yellow fever (YF) is an infectious disease that primarily affects the liver and has a high mortality rate. However, LT can be a viable option for treating rare cases with extensive liver involvement. However, the criteria for assessing the severity of ALF and determining the indications for transplantation have not been specifically validated for cases caused by YF.
AIM
To present necessary adjustments to established scoring systems for ALF secondary to YF.
METHODS
This was an observational, retrospective, single-center study. Fourteen consecutive patients with confirmed ALF due to YF were monitored in the intensive care unit by a specialized liver transplant team during a three-month epidemic outbreak in Brazil. During hospitalization, general supportive therapeutic measures were implemented, and the patients were regularly assessed using the King's College criteria and the Clichy-Villejuif criteria to determine the severity of liver failure. LT is considered a viable measure for patients with signs of end-stage liver failure.
RESULTS
Eight of 14 (57%) patients developed severe neurological alterations within the first 96 hours after hospital admission. Four patients underwent emergency LT, and despite a moderate viral infection of the graft after transplantation, the 5-year survival rate was 50%. Although the King's College criteria and the Clichy-Villejuif criteria are the main scoring systems for ALF, they are insufficient for predicting the risk of mortality in this context, primarily because of low serum bilirubin levels in the final stage of the disease and significant disparities between coagulation abnormalities and patient severity.
CONCLUSION
To ensure good applicability in cases of YF-induced ALF, the authors suggest adaptations to the King's College and Clichy-Villejuif criteria.
Core Tip: This study describes the application of current liver transplantation (LT) scoring systems, the King's College criteria and the Clichy-Villejuif criteria, for predicting outcomes in patients with acute liver failure (ALF) due to yellow fever (YF). We focused on 14 patients with confirmed ALF due to YF who were monitored by a liver transplant team during an epidemic in Brazil. Four patients underwent emergency LT following adaptations to the aforementioned scoring systems. The 5-year survival rate was 50%. These findings highlight the need to revise the criteria for transplantation for YF-associated ALF and demonstrate that LT can be a viable, life-saving option in specific cases.
