Lamivudine has been shown to improve liver function and reduce the need for
liver transplantation (LT) in patients with decompensated
HBeAg-positive
cirrhosis. Nevertheless, there is only limited experience with
lamivudine in patients with anti-HBe-positive/
HBeAg-negative
cirrhosis. The primary aim of this study was to determine whether
lamivudine treatment improves liver function and subsequently pre-LT survival or delays or obviates the need for LT in patients with anti-HBe-positive/
HBeAg-negative
cirrhosis. Between July 1998 and June 2003, 20 consecutive patients awaiting LT were enrolled in the study. All patients showed active viral replication and were treated with
lamivudine 100 mg daily. Significant clinical improvement, defined as a decrease in the Child-Pugh-Turcotte score by >or=2 points, was observed in 11 (55%) patients. The median change in the Child-Pugh-Turcotte score was -2 (range -5 to +2). The median time required to achieve a 2-point or greater reduction in Child-Pugh-Turcotte score was 6 months (range 3-12 months). In nine patients (45%), the Child-Pugh-Turcotte score decreased to <or=6 (Child's class A
cirrhosis). At last follow-up, 14 (70%) patients were alive and waiting for LT, with a median LT-free survival of 36 months (range 12-63 months). One patient (5%) developed resistance to
lamivudine with reappearance of HBV
DNA after 48 months of treatment. In conclusion, our results provide further evidence to the notion that
lamivudine is beneficial in patients with decompensated anti-HBe-positive/
HBeAg-negative
cirrhosis caused by actively replicating
chronic hepatitis B.