Lamivudine therapy for decompensated liver cirrhosis related to hepatitis B virus infection

Chronic hepatitis B virus (HBV) infection is the major cause of chronic liver disease worldwide. Although the clinical course of HBV infection varies widely, the prognosis of decompensated liver cirrhosis is quite poor and the 5-year survival rate has been estimated to be only 14-35%. While the ultimate treatment of decompensated cirrhosis is orthotopic liver transplantation (OLT), recent studies have suggested that lamivudine can also improve the clinical outcomes in this group of patients. Lamivudine rapidly suppresses HBV replication and can improve several parameters of liver function tests and afford prolonged periods of pretransplantation survival. However, the proportion of clinical improvement as defined by a decrease in Child-Pugh score as well as the prolonged survival rate varied widely from study to study. These discrepancies might result from differences in the severity of cirrhosis at entry, the presence of active viral replication or inflammation, and the proportions of patients who received OLT during the study period. Overall, about half of the patients achieved a clinical improvement with lamivudine therapy. However, data are still lacking on whether lamivudine can prolong survival before OLT and even replace OLT. Most of the deaths or clinical improvement occurred or started to occur within the first 6 months of treatment. Therefore, OLT should be actively considered in patients with risk factors for early mortality or those without clinical improvement within the first 6 months of lamivudine treatment.