Clinical Outcomes of Lamivudine-Adefovir Therapy in Chronic Hepatitis B Cirrhosis

Goals: To determine the clinical outcome of chronic hepatitis B cirrhotics on antiviral therapy. Background: The long-term outcome of hepatitis B cirrhotics on therapy remains to be characterized. Methods: A large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled in a treatment program of lamivudine +/- adefovir therapy. Patients were analyzed for clinical outcomes, and predictors of these outcomes were evaluated by multivariate analysis. Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease score, and mortality were assessed. Data were analyzed by Kaplan-Meier graphs, log-rank test, and Cox regression. Results: Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC, encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%, and 16.9%, respectively. The overall progression of liver-related complications was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin <= 28 g/L, Child-Pugh score >= 7.9, Model for End-stage Liver Disease score >= 10.9 were significantly associated with liver-related complications. Low albumin and low hepatitis B virus DNA were independent factors for liver-associated mortality. Lamivudine resistance did not affect mortality or liver disease progression. When stratified by Child-Pugh status, the mean survival of those with Child C cirrhosis was worse than Child A and B cirrhosis (P < 0.001, log-rank test). Early deaths (<= 12 mo) were due to liver failure or sepsis, whereas deaths >= 12mo were mainly due to HCC. Conclusion: Decompensated chronic hepatitis B cirrhotics may suffer early mortality despite antiviral treatment, and therefore should be considered for early liver transplantation.