Maggie M G Ow1, Janak R de Zoysa, Edward J Gane. 1. South West Liver Unit, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, United Kingdom. mow001@aucklanduni.ac.nz.
Abstract
AIMS: Hepatitis B (HBV) is an important cause of morbidity and mortality in end-stage renal disease patients. The effect of oral antiviral therapy on survival in this population is not known. We evaluated the impact of oral antivirals on survival of HBV-infected haemodialysis patients. METHOD: This retrospective study included 52 HBsAg-positive haemodialysis patients and 156 non-infected haemodialysis controls. Criteria adopted for starting lamivudine were the 2001 American Association for the Study of Liver Diseases guidelines. Lamivudine was commenced in 21 (40.4%) patients, with median treatment duration of 58 months. The primary endpoint was transplant-free survival. RESULTS: Survival of HBsAg-positive patients was equivalent to that of age- and sex-matched HBsAg-negative controls (39.1% vs 33.2% at 10 years, respectively; P=0.12). In treated patients, complete viral suppression was associated with improved survival (serial HBV DNA less than and equal to 2 log10 IU/mL, 90.9% vs HBV DNA >2 log10 IU/mL on at least one occasion, 74.1% at 5 years; P=0.049). Out of 20 deaths, three were liver-related. CONCLUSION: Haemodialysis patients with chronic HBV, when given oral antiviral therapy if indicated, had equivalent long-term survival to that of non-infected controls. In those with active viral hepatitis, viral suppression was associated with reduced liver-related mortality.
AIMS: Hepatitis B (HBV) is an important cause of morbidity and mortality in end-stage renal diseasepatients. The effect of oral antiviral therapy on survival in this population is not known. We evaluated the impact of oral antivirals on survival of HBV-infected haemodialysispatients. METHOD: This retrospective study included 52 HBsAg-positive haemodialysis patients and 156 non-infected haemodialysis controls. Criteria adopted for starting lamivudine were the 2001 American Association for the Study of Liver Diseases guidelines. Lamivudine was commenced in 21 (40.4%) patients, with median treatment duration of 58 months. The primary endpoint was transplant-free survival. RESULTS: Survival of HBsAg-positive patients was equivalent to that of age- and sex-matched HBsAg-negative controls (39.1% vs 33.2% at 10 years, respectively; P=0.12). In treated patients, complete viral suppression was associated with improved survival (serial HBV DNA less than and equal to 2 log10 IU/mL, 90.9% vs HBV DNA >2 log10 IU/mL on at least one occasion, 74.1% at 5 years; P=0.049). Out of 20 deaths, three were liver-related. CONCLUSION: Haemodialysis patients with chronic HBV, when given oral antiviral therapy if indicated, had equivalent long-term survival to that of non-infected controls. In those with active viral hepatitis, viral suppression was associated with reduced liver-related mortality.