Extension of transplantation free time by lamivudine in patients with hepatitis B-induced decompensated cirrhosis.
BACKGROUND
Liver transplantation for hepatitis B virus (HBV)-induced cirrhosis carries a high risk of graft reinfection and poor prognosis. Active viral replication is considered a contraindication for transplantation in most centers. Lamivudine, a new nucleoside analog, is a potent inhibitor of HBV replication that has been used safely for pretransplantation suppression of HBV replication.


METHODS
We report the pattern of response to lamivudine treatment in three consecutive patients with decompensated cirrhosis due to the replicative phase of chronic HBV infection.


RESULTS
In addition to virological and biochemical response, impressive clinical improvement was noted in all three patients, with disappearance of the ascites and marked improvement of synthetic liver function tests. One patient converted to anti-hepatitis B surface and is free of symptoms 20 months after initiation of treatment. The other two patients experienced significant clinical improvement for 8 to 9 months and were removed from the waiting list for transplantation. However, progressive liver disease recurred in both patients--one underwent liver transplantation and the other is a candidate for the procedure.


CONCLUSIONS
The administration of lamivudine for pretransplantation HBV suppression was associated with impressive clinical and biochemical improvement. Lamivudine may extend the transplantation free time in such patients. The mechanism of this desirable effect should be explored.
Kitay-Cohen
Y
Y
Department of Medicine, Meir Hospital, Kfar-Saba, Israel. yona@gold.net.il
Ben-Ari
Z
Z
Tur-Kaspa
R
R
Fainguelernt
H
H
Lishner
M
M
D000328:Adult; D006509:Hepatitis B / Q000150:complications* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000628:therapy* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine