May 15th
Abstract ID: S1497
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.