Lamivudine Treatment Is Beneficial in Patients With... : Hepatology (original) (raw)
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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
Yao, Francis Y.*,1; Terrault, Norah A.1; Freise, Chris2; Maslow, Lin1; Bass, Nathan M.1
1_Department of Medicine, Division of Gastroenterology, University of California, San Francisco, CA._
2_Department of Surgery, University of California, San Francisco, CA._
* University of California, San Francisco, Box 0538, 513 Parnassus Avenue, Room S–357, San Francisco, CA 94143–0538. fax: 415–476–0659; E-mail: [email protected].
Received: 11 April 2001; Accepted: 23 May 2001
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.
Copyright © 2001 American Association for the Study of Liver Diseases.