Lamivudine treatment is beneficial in patients with severely decompensatedcirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: A comparative study using a matched, untreated cohort

Uncontrolled studies have suggested a beneficial effect of lamivudine in pa tients with decompensated cirrhosis caused by replicating hepatitis B virus (HBV). We analyzed the outcome of lamivudine treatment in 23 consecutive p atients with severely decompensated HBV-cirrhosis defined as a Child-Pugh-T urcotte (CPT) score of greater than or equal to 10, and compared with a his torical untreated control group of 23 patients matched for age, gender, and baseline CPT score. Significant clinical response, defined as a decrease i n the CPT score by greater than or equal to3 points, was observed in 14 of 23 (60.9%) treated patients versus none of the controls (P < .0001). The me dian change in CPT scores was -3.0 (range, -6 to +3) in the treated group v ersus +1.0 in the controls (range, -1 to +2) (P = .016). Orthotopic liver t ransplantation (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 mo nths, respectively, Our results suggest that lamivudine significantly impro ves hepatic function in over half of the patients with decompensated cirrho sis and replicating HBV, and may confer a survival advantage. However, the small sample size and the use of a retrospective control cohort preclude dr awing definitive conclusions. Expedited OLT remains the only viable treatme nt for lamivudine nonresponders.