Lamivudine treatment of advanced and decompensated liver disease due to hepatitis B.

The purpose of this study was to evaluate the effectiveness and safety of lamivudine treatment in patients with advanced and end-stage liver disease caused by hepatitis B. Nine cases of advanced or end-stage liver disease due to hepatitis B infection were treated with lamivudine. Four received liver transplants while receiving lamivudine. Moreover, each of these four has been maintained on lamivudine therapy post-transplantation while receiving immunosuppression. No cases of HBV reactivation have been seen. More importantly, the allograft liver tissue has been HBc and HBs antigen negative as well as HBV-DNA negative by PCR. This report suggests that: 1) lamivudine can be given safely to liver transplant candidates; 2) lamivudine suppresses HBV replication, so much so that HBV-DNA becomes undetectable in the serum; 3) despite powerful immunosuppression associated with transplantation, HBV reactivation does not occur under lamivudine therapy; and 4) the observations should cause transplant physicians, surgeons and third-party payers to reconsider their positions relative to transplantation of individuals with HBV-associated cirrhosis.