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Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: A comparative study using a matched, untreated cohort
Author(s) -
Yao Francis Y.,
Terrault Norah A.,
Freise Chris,
Maslow Lin,
Bass Nathan M.
Publication year - 2001
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2001.26512
Subject(s) - lamivudine , medicine , cirrhosis , gastroenterology , liver transplantation , cohort , retrospective cohort study , transplantation , hepatitis b , hepatitis b virus , surgery , immunology , virus
Abstract Uncontrolled studies have suggested a beneficial effect of lamivudine in patients with decompensated cirrhosis caused by replicating hepatitis B virus (HBV). We analyzed the outcome of lamivudine treatment in 23 consecutive patients with severely decompensated HBV‐cirrhosis defined as a Child‐Pugh‐Turcotte (CPT) score of ≥10, and compared with a historical untreated control group of 23 patients matched for age, gender, and baseline CPT score. Significant clinical response, defined as a decrease in the CPT score by ≥3 points, was observed in 14 of 23 (60.9%) treated patients versus none of the controls ( P < .0001). The median change in CPT scores was −3.0 (range, −6 to +3) in the treated group versus +1.0 in the controls (range, −1 to +2) ( P = .016). Orthotopic liver transplantation (OLT) was performed in 34.8% of treated patients (median, 3.5; range, 1‐32 months), versus 73.9% of controls (median, 3.0; range, 1‐14 months) ( P = .04). Excluding transplanted patients, there were no deaths in the treated group versus 6 deaths in the control group ( P = .009). Time to death or OLT was significantly longer in treated patients than in controls ( P < .001). Two patients developed lamivudine resistance after 9 and 12 months, respectively. Our results suggest that lamivudine significantly improves hepatic function in over half of the patients with decompensated cirrhosis and replicating HBV, and may confer a survival advantage. However, the small sample size and the use of a retrospective control cohort preclude drawing definitive conclusions. Expedited OLT remains the only viable treatment for lamivudine nonresponders.