MELD Score, Virologic Response Associated With Transplant-Free Survival in HBV-Related Cirrhosis

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Baseline model for end-stage liver disease score >20 and multiple complications were associated with short-term mortality in decompensated cirrhosis.
Baseline model for end-stage liver disease score >20 and multiple complications were associated with short-term mortality in decompensated cirrhosis.

For patients with hepatitis B virus (HBV)-related decompensated cirrhosis, baseline model for end-stage liver disease (MELD) score and maintained virologic response (MVR) to entecavir or lamivudine are associated with short- and long-term transplant-free survival, according to results published in Clinical Gastroenterology and Hepatology.

The study included data from the Epidemiology and Natural History of Liver Cirrhosis study of patients with decompensated liver cirrhosis in Korea. Of the 1595 enrolled participants, the researchers analyzed 295 participants who immediately began treatment with entecavir (n=179) or lamivudine (n=116) after decompensation.

The primary endpoint was time of liver transplant-free survival.

The median survival time was 7.7 years, with 60.1% of participants surviving for 5 years and 45.7% surviving for 10 years without liver transplantation.

A total of 39.3% (n=116) participants achieved MVR, and these participants had significantly longer durations of transplant-free survival compared with participants who did not achieve MVR.

MVR was the factor with the strongest association with long-term, transplant-free survival. The benefits of MVR were maintained for up to 10 years.

Baseline MELD score >20 and multiple complications were associated with short-term mortality.

The survival rates of participants without hepatocellular carcinoma were excellent if they survived the first 6 months after initiation of antiviral therapy. However, the survival rates of participants with hepatocellular carcinoma decreased persistently over time.

"Our study demonstrates for the first time that the benefits of an MVR are maintained for up to 10 years with significantly improved liver function even after decompensation, but patients are still at risk for [hepatocellular carcinoma], highlighting the importance of close [hepatocellular carcinoma] surveillance," the study authors concluded.

Reference

Jang JW, Choi JY, Kim YS, et al. Effects of virologic response to treatment on short- and long-term outcomes of patients with chronic HBV infection and decompensated cirrhosis [published online May 9, 2018]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2018.04.063

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