Extension of Transplantation Free Time by Lamivudine in Patients With Hepatitis B-Induced Decompensated Cirrhosis

Kitay-Cohen, Yona; Ben‐Ari, Ziv; Tur–Kaspa, Ran; Fainguelernt, Haia; Lishner, Michael

doi:10.1097/00007890-200006150-00028

Cited by 21 publications

(18 citation statements)

References 7 publications

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“…The safety and efficacy of lamivudine has been evaluated in transplant patients with end‐stage liver disease caused by chronic HBV infection [20–22]. In the present study, lamivudine administration before transplantation (group 1) extended the transplantation‐free time in two patients, served as a bridge to OLT, and led to clearance of HBV from serum in all patients, thereby enabling nine of them to undergo OLT.…”

Section: Discussionmentioning

confidence: 84%

“…In a previous study [21], our group found that the administration of lamivudine in patients with active viral replication before transplantation suppressed HBV replication and induced clinical and biochemical improvement, extending the transplantation‐free time. Accordingly, others [22, 23] noted an improvement in Child–Pugh–Turcot scores in 69% of patients with HBV infection treated with lamivudine; 38% were placed on inactive status for liver transplantation [23].…”

Section: Discussionmentioning

confidence: 99%

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Experience with lamivudine therapy for hepatitis B virus infection before and after liver transplantation, and review of the literature

Ben‐Ari

Tur–Kaspa

2003

Journal of Internal Medicine

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Objectives. To analyse the results of lamivudine therapy on suppression of hepatitis B virus (HBV) replication before transplantation and on preventing graft reinfection postoperatively. Design. Long-term clinical study. Setting. Liver Institute and Department of Transplantation of a tertiary-care university-affiliated centre. Subjects. (1) 14 candidates for liver transplantation with decompensated liver disease caused by active replication of HBV; (2) six patients with recurrent HBV infection after transplantation. Intervention. Lamivudine 100 mg daily; administered in group 1 before surgery and continued after in nine patients who underwent transplantation; administered in group two postoperatively only. antihepatitis B surface antigen immunoglobulin (HBIg) was administered postoperatively in both groups. Main outcome measures. Immunoassay evaluation of serum hepatitis B surface antigen, serum hepatitis Be antigen and serum HBV DNA (hybridization and PCR); sequencing through the tyrosine-methionineaspartate-aspartate locus of the HBV polymerase gene in patients with lamivudine breakthrough; inflammation and fibrosis scoring on liver biopsy before and at least 2 years after lamivudine therapy in group 2. Results. Pretransplantation therapy (group 1) significantly suppressed HBV replication and enabled nine patients (64.2%) to undergo transplantation. Only one patient (7.1%) had lamivudine breakthrough, and one (7.1%) had recurrent HBV. Lamivudine administration begun after transplantation (mean 48.0 months, range 30-60 months) because of graft reinfection (group 2) was associated, over the long-term, with the emergence of high mutation rates (83.3%), histological disease progression (66.6%), and hepatic failure (33.3%). Conclusions. In patients with chronic HBV infection and active viral replication, lamivudine therapy is effective when started before transplantation. However, its long-term administration after transplantation for recurrent HBV leads to high resistance rates. Combination therapy with lamivudine and HBIg immunoglobulin can substantially reduce the recurrence rate. Further studies on combination antiviral therapy are needed in this patient population.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Experience with lamivudine therapy for hepatitis B virus infection before and after liver transplantation, and review of the literature

Ben‐Ari

Tur–Kaspa

2003

Journal of Internal Medicine

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“…Prophylaxis with LAM is also effective in preventing recurrent HBV infection and graft reinfection after transplantation, although the emergence of YMDD‐variant HBV may occur 8,9 , 12–14 . Most patients still continue to benefit from LAM treatment even after the emergence of YMDD‐variant HBV.…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports have suggested that LAM can improve and stabilize some patients with end‐stage liver disease, leading to increased pre‐transplant survival as well as a reduced need for transplantation 7–9 . However, the data for the efficacy of long‐term LAM therapy in patients with decompensated liver disease associated with viral replication, liver function and safety profile are limited to date.…”

Section: Introductionmentioning

confidence: 99%

Timing of lamivudine administration according to Child class in patients with decompensated cirrhosis

Bae

Yoon

Choi

et al. 2005

J of Gastro and Hepatol

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“…Other interventions that may have prolonged transplant-free survival (e.g., TIPS, use of prophylactic antibiotics) may have contributed to the observed improvements in clinical outcomes. In spite of all these inadequacies, lamivudine was found to be safe in patients with decompensated HBV cirrhosis although not all patients benefited from it [67]. Clinical improvement usually occurs between 3 to 6 months of therapy and improvement might not occur if treatment is started late.…”

Section: Lamivudinementioning

confidence: 99%

Treatment of Hepatitis B in Decompensated Liver Cirrhosis

Guan

Lui

2011

International Journal of Hepatology

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Chronic hepatitis B infection progresses from an asymptomatic persistently infected state to chronic hepatitis, cirrhosis, decompensated liver disease, and/or hepatocellular carcinoma. About 3% of patients with chronic hepatitis develop cirrhosis yearly, and about 5% of individuals with hepatitis B cirrhosis become decompensated annually. The outcome for patients with decompensated cirrhosis is bleak. Lamivudine, the first oral antiviral agent available for hepatitis B treatment is safe and effective and can improve or stabilize liver disease in patients with advanced cirrhosis and viraemia. Viral resistance restricts its prolonged use. Entecavir and tenofovir are newer agents with excellent resistance profile to date. These and some other antiviral agents are being investigated for optimal use in this rather challenging patient group.

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Extension of Transplantation Free Time by Lamivudine in Patients With Hepatitis B-Induced Decompensated Cirrhosis

Abstract: 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.

Cited by 21 publications

References 7 publications

Experience with lamivudine therapy for hepatitis B virus infection before and after liver transplantation, and review of the literature

Experience with lamivudine therapy for hepatitis B virus infection before and after liver transplantation, and review of the literature

Timing of lamivudine administration according to Child class in patients with decompensated cirrhosis

Treatment of Hepatitis B in Decompensated Liver Cirrhosis

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