Jeong Won Jang1, Jong Young Choi2, Young Seok Kim3, Jeong-Ju Yoo4, Hyun Young Woo5, Sung Kyu Choi6, Chung Hwan Jun6, Chang Hyeong Lee7, Joo Hyun Sohn8, Won Young Tak9, Yu Rim Lee9, Kwang-Hyub Han10. 1. Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Liver Cirrhosis Clinical Research Center. 2. Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Liver Cirrhosis Clinical Research Center. Electronic address: jychoi@catholic.ac.kr. 3. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. Electronic address: liverkys@schmc.ac.kr. 4. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. 5. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Pusan National University Hospital, Busan, Korea. 6. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. 7. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. 8. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea. 9. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Daegu, Korea. 10. Liver Cirrhosis Clinical Research Center; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND & AIMS: Little is known about the effects of antiviral therapy on short- and long-term survival of patients with hepatitis B virus (HBV)-related decompensated cirrhosis. We aimed to determine whether a maintained virologic response (MVR, defined as persistent undetectable HBV DNA during therapy) associates with short-term (6 mo) and long-term (6-120 mo) survival of patients with decompensated cirrhosis. METHODS: We performed a 10-year observation analysis using data from the Epidemiology and Natural History of Liver Cirrhosis study of patients with decompensated liver cirrhosis in Korea. Of the entire cohort (1595 patients enrolled at onset of decompensation since 2005), our analysis comprised 295 patients who immediately began treatment with entecavir (n = 179) or lamivudine (n = 116) after decompensation. We collected laboratory test results, data on hepatocellular carcinoma (HCC) development, and Child-Turcotte-Pugh and model for end-stage liver disease (MELD) scores. The mean follow-up time was 62.3 ± 36.5 months. The primary end point was time of liver transplant-free survival. RESULTS: The median survival time was 7.7 years; 60.1% of patients survived for 5 years and 45.7% survived for 10 years without liver transplantation. An MVR was observed in 116 patients (39.3%); these patients had significantly longer times of transplant-free survival than patients without MVR. Survival times associated with the occurrence of HCC; survival of patients without HCC was excellent if they survived the first 6 months after initiation of antiviral therapy, whereas the survival rates of patients with HCC decreased persistently over time. A baseline MELD score above 20 and multiple complications were associated with short-term mortality. MVR was the factor most strongly associated with long-term transplant-free survival. Significantly higher proportions of patients who received entecavir survived 10 years compared with patients who received lamivudine, but no difference was observed among patients with MVRs. Patients with MVRs had significant improvement in hepatic function over time, but nonsignificant reductions in risk of HCC or HCC-related mortality. CONCLUSIONS: In a 10-year observation study of patients in Korea with HBV-related decompensated cirrhosis, we found baseline MELD score and MVR to entecavir or lamivudine to associate with short- and long-term transplant-free survival. The benefits of an MVR are maintained for up to 10 years even after decompensation, but patients are still at risk for HCC.
BACKGROUND & AIMS: Little is known about the effects of antiviral therapy on short- and long-term survival of patients with hepatitis B virus (HBV)-related decompensated cirrhosis. We aimed to determine whether a maintained virologic response (MVR, defined as persistent undetectable HBV DNA during therapy) associates with short-term (6 mo) and long-term (6-120 mo) survival of patients with decompensated cirrhosis. METHODS: We performed a 10-year observation analysis using data from the Epidemiology and Natural History of Liver Cirrhosis study of patients with decompensated liver cirrhosis in Korea. Of the entire cohort (1595 patients enrolled at onset of decompensation since 2005), our analysis comprised 295 patients who immediately began treatment with entecavir (n = 179) or lamivudine (n = 116) after decompensation. We collected laboratory test results, data on hepatocellular carcinoma (HCC) development, and Child-Turcotte-Pugh and model for end-stage liver disease (MELD) scores. The mean follow-up time was 62.3 ± 36.5 months. The primary end point was time of liver transplant-free survival. RESULTS: The median survival time was 7.7 years; 60.1% of patients survived for 5 years and 45.7% survived for 10 years without liver transplantation. An MVR was observed in 116 patients (39.3%); these patients had significantly longer times of transplant-free survival than patients without MVR. Survival times associated with the occurrence of HCC; survival of patients without HCC was excellent if they survived the first 6 months after initiation of antiviral therapy, whereas the survival rates of patients with HCC decreased persistently over time. A baseline MELD score above 20 and multiple complications were associated with short-term mortality. MVR was the factor most strongly associated with long-term transplant-free survival. Significantly higher proportions of patients who received entecavir survived 10 years compared with patients who received lamivudine, but no difference was observed among patients with MVRs. Patients with MVRs had significant improvement in hepatic function over time, but nonsignificant reductions in risk of HCC or HCC-related mortality. CONCLUSIONS: In a 10-year observation study of patients in Korea with HBV-related decompensated cirrhosis, we found baseline MELD score and MVR to entecavir or lamivudine to associate with short- and long-term transplant-free survival. The benefits of an MVR are maintained for up to 10 years even after decompensation, but patients are still at risk for HCC.
Authors: Sung Won Lee; Jung Hyun Kwon; Hae Lim Lee; Sun Hong Yoo; Hee Chul Nam; Pil Soo Sung; Soon Woo Nam; Si Hyun Bae; Jong Young Choi; Seung Kew Yoon; Nam Ik Han; Jeong Won Jang Journal: Gut Date: 2019-10-31 Impact factor: 23.059