The team investigated the effect of lamivudine on survival of patients awaiting liver transplantation for hepatitis B virus-related cirrhosis.
They reported their results in the May issue of Liver Transplantation.
A total of 162 lamivudine-treated and 147 untreated transplant candidates were included in the study.
All were managed at 20 North American transplant centers, between 1996 and 1998.
Data was collected on the patients and compared.
Lamivudine-treated patients were more likely to be men, hepatitis B e antigen-positive, HBV DNA-positive, and have lower serum albumin levels at listing.
Actuarial improved pre-liver transplantation (pre-LT) and LT-free survival rates were found to be similar in lamivudine-treated and untreated patients.
Using Cox regression analysis, the only significant predictor of pre-LT patient survival was the modified Child-Turcotte-Pugh (mCTP) score.
Significant predictors of LT-free survival included ethnic background, lamivudine treatment, indication for LT, baseline serum alanine aminotransferase level, and baseline mCTP score.
The researchers found that lamivudine had no apparent effect on liver disease severity in patients undergoing LT.
However, it appeared to improve disease severity in patients still awaiting LT.
| Survival rates similar in lamivudine-treated and untreated patients.
| Liver Transplantation |
Breakthrough infection was noted in 11% of lamivudine-treated patients.
Robert J. Fontana, of the University of Michigan Medical Center, Ann Arbor, said on behalf of his colleagues, "We conclude that lamivudine therapy is not associated with improved pre-LT or LT-free survival in LT candidates with chronic hepatitis B.
"However, a subset of patients with less advanced liver failure may derive clinical benefit from lamivudine therapy, thus delaying the need for LT."
"In the absence of prospective, randomized, controlled trials of lamivudine in patients with decompensated cirrhosis, careful selection of patients and optimal timing of treatment are needed.
"This is so that one can balance the risk versus benefit of lamivudine therapy in LT candidates," he concluded.