BACKGROUND & AIMS: Lamivudine has been shown to improve liver disease and survival of hepatitis B virus patients on the orthotopic liver transplantation (OLT) waiting list, but liver failure might worsen in patients with drug resistance. Use of antiviral salvage therapy might decrease this risk. METHODS: We analyzed data from patients enrolled in the NIH HBV OLT cohort to study the effects of pretransplant antiviral therapy on transplant-free survival and survival without transplant. We also compared the clinical outcomes of those who did or did not develop antiviral failure (virologic breakthrough or genotypic resistance) while awaiting transplant. RESULTS: One hundred twenty-two eligible patients received antiviral therapy before OLT and were followed for a median of 40.5 months (range, 0.4-123.0 months) after initiation of antiviral therapy. Forty-four (36.1%) patients developed antiviral failure; all had lamivudine monotherapy as initial treatment. Forty-two patients started salvage therapy a median of 5 months after lamivudine failure; the median Model for End-Stage Liver Disease (MELD) score was 12. Twenty-one (50%) patients had a full response to salvage therapy. Eleven (26.2%) patients had a suboptimal virologic response but remained clinically compensated. Antiviral failure was not a significant predictor of transplant or death (P = .09) or death without transplant (P = .39). Multivariate predictors of transplant or death were high MELD score, hepatocellular carcinoma, and low albumin. High MELD score and low albumin were predictors of death without transplant. CONCLUSIONS: Antiviral failure in patients with HBV on the OLT waiting list did not impair clinical outcome if recognized early and if salvage therapy is promptly initiated.
BACKGROUND & AIMS:Lamivudine has been shown to improve liver disease and survival of hepatitis B viruspatients on the orthotopic liver transplantation (OLT) waiting list, but liver failure might worsen in patients with drug resistance. Use of antiviral salvage therapy might decrease this risk. METHODS: We analyzed data from patients enrolled in the NIH HBV OLT cohort to study the effects of pretransplant antiviral therapy on transplant-free survival and survival without transplant. We also compared the clinical outcomes of those who did or did not develop antiviral failure (virologic breakthrough or genotypic resistance) while awaiting transplant. RESULTS: One hundred twenty-two eligible patients received antiviral therapy before OLT and were followed for a median of 40.5 months (range, 0.4-123.0 months) after initiation of antiviral therapy. Forty-four (36.1%) patients developed antiviral failure; all had lamivudine monotherapy as initial treatment. Forty-two patients started salvage therapy a median of 5 months after lamivudine failure; the median Model for End-Stage Liver Disease (MELD) score was 12. Twenty-one (50%) patients had a full response to salvage therapy. Eleven (26.2%) patients had a suboptimal virologic response but remained clinically compensated. Antiviral failure was not a significant predictor of transplant or death (P = .09) or death without transplant (P = .39). Multivariate predictors of transplant or death were high MELD score, hepatocellular carcinoma, and low albumin. High MELD score and low albumin were predictors of death without transplant. CONCLUSIONS: Antiviral failure in patients with HBV on the OLT waiting list did not impair clinical outcome if recognized early and if salvage therapy is promptly initiated.
Authors: J P Villeneuve; L D Condreay; B Willems; G Pomier-Layrargues; D Fenyves; M Bilodeau; R Leduc; K Peltekian; F Wong; M Margulies; E J Heathcote Journal: Hepatology Date: 2000-01 Impact factor: 17.425
Authors: Robert J Fontana; Emmet B Keeffe; William Carey; Michael Fried; Rajender Reddy; Kris V Kowdley; Consuelo Soldevila-Pico; Leslie A McClure; Anna S F Lok Journal: Liver Transpl Date: 2002-05 Impact factor: 5.799
Authors: N W Leung; C L Lai; T T Chang; R Guan; C M Lee; K Y Ng; S G Lim; P C Wu; J C Dent; S Edmundson; L D Condreay; R N Chien Journal: Hepatology Date: 2001-06 Impact factor: 17.425
Authors: Hie-Won L Hann; Robert J Fontana; Teresa Wright; Gregory Everson; Alfred Baker; Eugene R Schiff; Carolyn Riely; Gaya Anschuetz; Stephen D Gardner; Nathaniel Brown; Dorothea Griffiths Journal: Liver Transpl Date: 2003-01 Impact factor: 5.799
Authors: Robert Perrillo; Hie-Won Hann; David Mutimer; Bernard Willems; Nancy Leung; William M Lee; Alison Moorat; Stephen Gardner; Mary Woessner; Eric Bourne; Carol L Brosgart; Eugene Schiff Journal: Gastroenterology Date: 2004-01 Impact factor: 22.682
Authors: Robert J Fontana; Hie-Won L Hann; Robert P Perrillo; John M Vierling; Theresa Wright; Jorge Rakela; Gaya Anschuetz; Randy Davis; Stephen D Gardner; Nathaniel A Brown Journal: Gastroenterology Date: 2002-09 Impact factor: 22.682
Authors: Eugene R Schiff; Ching-Lung Lai; Stefanos Hadziyannis; Peter Neuhaus; Norah Terrault; Massimo Colombo; Hans L Tillmann; Didier Samuel; Stefan Zeuzem; Leslie Lilly; Maria Rendina; Jean-Pierre Villeneuve; Nicole Lama; Craig James; Michael S Wulfsohn; Hamid Namini; Christopher Westland; Shelly Xiong; Gavin S Choy; Sally Van Doren; John Fry; Carol L Brosgart Journal: Hepatology Date: 2003-12 Impact factor: 17.425
Authors: B Degertekin; Steven-Huy B Han; E B Keeffe; E R Schiff; V A Luketic; R S Brown; S Emre; C Soldevila-Pico; K R Reddy; M B Ishitani; T T Tran; T L Pruett; A S F Lok Journal: Am J Transplant Date: 2010-03-23 Impact factor: 8.086