Effect of antiviral therapy on the survival and incidence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension

Virology Journal

Fanfan Xing²  Yawen Wang²  Yi Lv¹  Qianqian Zhu²  Na Li²  Qunying Han²  Guoyu Zhang²  Zhu Li²  Mingbo Yang²  Zhengwen Liu¹  Ningqiang Tian² 

[1] Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi’ an, Shaanxi, 710061, China;Department of Infectious Diseases, First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’ an, 710061, Shaanxi, China

关键词: Portal hypertension;    Hypersplenism;    Splenectomy;    Antiviral therapy;    Cirrhosis;    Hepatitis B virus;   

Others  :  1153190
DOI  :  10.1186/1743-422X-9-273

 received in 2012-01-22, accepted in 2012-11-14,  发布年份 2012

【 摘 要 】

Background

Splenectomy remains a common approach for the management of hypersplenism and portal hypertension in hepatitis B virus (HBV)-associated cirrhotic patients in China and some other Asian countries. The effects of antiviral therapy on the survival and occurrence of complications in asplenic HBV-associated cirrhotic patients are unknown. This study analyzed the effect of antiviral therapy on survival and occurrence of major complications in HBV-associated cirrhotic patients after splenectomy for hypersplenism and portal hypertension.

Results

Of the 57 eligible patients for analysis, 28 patients received nucleos(t)ide analogs (treatment group) for antiviral treatment after splenectomy, while 29 patients received no antiviral treatment (control group). After a median of 3 years and 9 months, the overall survival and complication-free survival in the treatment group were higher though not statistically significant than those in the control group. Multivariate analysis showed that antiviral treatment was associated with increased but not statistically significant overall survival (hazard ratio (HR): 2.272, 95% confidence interval (CI): 0.952–5.424, P = 0.064) and the antiviral treatment was significantly associated with increased complication-free survival of the patients (HR: 7.229, 95% CI: 1.271–41.117, P = 0.026). The complication-free survival in patients aged ≤ 40 years was higher than that in patients aged > 40 years in the antiviral treatment patients (P = 0.020).

Conclusions

Antiviral therapy initiating after splenectomy may reduce the incidence of complications and tend to improve the survival in asplenic HBV-associated cirrhotic patients, especially in younger patients, supporting the use of antiviral therapy in these patients after splenectomy.

【 授权许可】

   
2012 Tian et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Lok AS, McMahon BJ: Chronic hepatitis B: update 2009. Hepatology 2009, 50:661-662.
• [2]Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, Tao QM, Shue K, Keene ON, Dixon JS, Gray DF, Sabbat J: Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004, 351:1521-1531.
• [3]Yuen MF, Fong DY, Wong DK, Yuen JC, Fung J, Lai CL: Hepatitis B virus DNA levels at week 4 of lamivudine treatment predict the 5-year ideal response. Hepatology 2007, 46:1695-1703.
• [4]Villeneuve JP, Condreay LD, Willems B, Pomier-Layrargues G, Fenyves D: Lamivudine treatment for decompensated cirrhosis resulting from chronic hepatitis B. Hepatology 2000, 31:207-210.
• [5]Kanwal F, Farid M, Martin P, Chen G, Gralnek IM, Dulai GS, Spiegel BM: Treatment alternatives for hepatitis B cirrhosis: a cost-effectiveness analysis. Am J Gastroenterol 2006, 101:2076-2089.
• [6]Kim JH, Park JW, Koh DW, Lee WJ, Kim CM: Efficacy of lamivudine on hepatitis B viral status and liver function in patients with hepatitis B virus-related hepatocellular carcinoma. Liver Int 2009, 29:203-207.
• [7]Kuzuya T, Katano Y, Kumada T, Toyoda H, Nakano I, Hirooka Y, Itoh A, Ishigami M, Hayashi K, Honda T, Goto H: Efficacy of antiviral therapy with lamivudine after initial treatment for hepatitis B virus-related hepatocellular carcinoma. J Gastroenterol Hepatol 2007, 22:1929-1935.
• [8]Chan AC, Chok KS, Yuen WK, Chan SC, Poon RT, Lo CM, Fan ST: Impact of antiviral therapy on the survival of patients after major hepatectomy for hepatitis B virus-related hepatocellular carcinoma. Arch Surg 2011, 146:675-681.
• [9]Zhang Y, Wen T, Yan L, Chen Z, Yang H, Deng X, Liang G, Li G, Zhang X, Ran S, Liao Z: The changes of hepatic hemodynamics and functional hepatic reserve after splenectomy with periesophagogastric devascularization. Hepatogastroenterology 2009, 56:835-839.
• [10]Soper NJ, Rikkers LF: Effect of operations for variceal hemorrhage on hypersplenism. Am J Surg 1982, 144:700-703.
• [11]Tomikawa M, Hashizume M, Saku M, Tanoue K, Ohta M, Sugimachi K: Effectiveness of gastric devascularization and splenectomy for patients with gastric varices. J Am Coll Surg 2000, 191:498-503.
• [12]Murata K, Ito K, Yoneda K, Shiraki K, Sakurai H, Ito M: Splenectomy improves liver function in patients with liver cirrhosis. Hepatogastroenterology 2008, 55:1407-1411.
• [13]Ushitora Y, Tashiro H, Takahashi S, Amano H, Oshita A, Kobayashi T, Chayama K, Ohdan H: Splenectomy in chronic hepatic disorders: portal vein thrombosis and improvement of liver function. Dig Surg 2011, 28:9-14.
• [14]Assy N, Gefen H, Schlesinger S, Karim W: Reactivation versus primary CMV infection after splenectomy in immunocompetent patients. Dig Dis Sci 2007, 52:3477-3479.
• [15]Styrt B: Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 1990, 88(5N):33N-42N.
• [16]Lammers AJ, Hoekstra JB, Speelman P, Lombarts KM: Physicians report barriers to deliver best practice care for asplenic patients: a cross-sectional survey. PLoS One 2011, 6:e17302.
• [17]Realdi G, Fattovich G, Hadziyannis S, Schalm SW, Almasio P, Sanchez-Tapias J, Christensen E, Giustina G, Noventa F: Survival and prognostic factors in 366 patients with compensated cirrhosis type B: a multicenter study. J Hepatol 1994, 21:656-666.
• [18]de Jongh FE, Janssen HL, de Man RA, Hop WC, Schalm SW, van Blankenstein M: Survival and prognostic indicators in hepatitis B surface antigen-positive cirrhosis of the liver. Gastroenterology 1992, 103:1630-1635.
• [19]Liaw YF: Management of YMDD mutations during lamivudine therapy in patients with chronic hepatitis B. J Gastroenterol Hepatol 2002, 17(Suppl 3):S333-S337.
• [20]Fung SK, Lok AS: Management of hepatitis B patients with antiviral resistance. Antivir Ther 2004, 9:1013-1026.
• [21]Lampertico P, Viganò M, Manenti E, Iavarone M, Lunghi G, Colombo M: Adefovir rapidly suppresses hepatitis B in HBeAg-negative patients developing genotypic resistance to lamivudine. Hepatology 2005, 42:1414-1419.
• [22]Sung JJ, Lai JY, Zeuzem S, Chow WC, Heathcote EJ, Perrillo RP, Brosgart CL, Woessner MA, Scott SA, Gray DF, Gardner SD: Lamivudine compared with lamivudine and adefovir dipivoxil for the treatment of HBeAg-positive chronic hepatitis B. J Hepatol 2008, 48:728-735.
• [23]van Bömmel F, Zöllner B, Sarrazin C, Spengler U, Hüppe D, Möller B, Feucht HH, Wiedenmann B, Berg T: Tenofovir for patients with lamivudine-resistant hepatitis B virus (HBV) infection and high HBV DNA level during adefovir therapy. Hepatology 2006, 44:318-325.
• [24]de Porto AP, Lammers AJ, Bennink RJ, ten Berge IJ, Speelman P, Hoekstra JB: Assessment of splenic function. Eur J Clin Microbiol Infect Dis 2010, 29:1465-1473.
• [25]Di Sabatino A, Carsetti R, Corazza GR: Post-splenectomy and hyposplenic states. Lancet 2011, 378:86-97.
• [26]Cameron PU, Jones P, Gorniak M, Dunster K, Paul E, Lewin S, Woolley I, Spelman D: Splenectomy associated changes in IgM memory B cells in an adult spleen registry cohort. PLoS One 2011, 6:e23164.