May 15th

 

Abstract ID: S1497

 

Lamivudine Ameliorates Severe Acute and Fulminant Hepatitis B; a Multicenter Experience

 

H.L. Tillmann,  , J. Hadem, L. Leifeld, K. Zachou, A. Canbay, C. Eisenbach, I. Graziadei, J. Encke, H. Schmidt, W. Vogel, A. Schneider, G. Gerken, U. Spengler, G.N. Dalekos, H. Wedemeyer, M.P. Manns

 

Introduction

Acute hepatitis B progresses to liver failure with the need of liver transplantation in about 1% of cases. Lamivudine is an oral nucleoside analogue inhibiting hepatitis B viral replication with an adverse event rate similar to placebo in chronic hepatitis B. We treated patients with severe acute or fulminant hepatitis B with lamivudine to prevent hepatitis B virus reinfection after liver transplantation.

 

Patients and Methods

Since September 2000, 17 patients with severe acute or fulminant hepatitis B virus infection were treated with 100 or 150mg lamivudine daily once we had evidence for a severe course as indicated by an INR >2.0 corresponding to a prothrombin time below 36% of normal. These were compared to a historic control from our unit and to external patients treated with or without lamivudine.

 

Results

Fourteen of the 17 patients (82.4%) survived with full recovery without liver transplantation. All these 14 individuals cleared HBsAg on lamivudine within less than six months after admission. Twelve patients recovered quickly as indicated by a normalized prothrombin time within one week while two patients had a more prolonged course. None of the patients showed an adverse event. Four patients requiring transplantation despite lamivudine therapy had more advanced disease on admission. One had additionally ingested paracetamol while the second was already HBV-DNA negative by PCR on admission. Two patients had no identifiable risk factor. The lamivudine treated patients had much higher frequency of survival without liver transplantation 82.4% than the historic controls (4/20 [20%]; p<0.001). Similar data were derived from external centers using lamivudine (15/20, [75%]; p=0.001), while two of three patients not receiving lamivudine did not survive without transplantation, recently.

 

Conclusion

Lamivudine is safe in patients with severe acute or fulminant hepatitis B, leading to fast recovery with the potential to prevent liver failure and liver transplantation when given early enough.