The impact of oral antiviral therapy on long-term survival of hepatitis B surface antigen-positive patients on haemodialysis.

AIMS: Hepatitis B (HBV) is an important cause of morbidity and mortality in end-stage renal disease patients. The effect of oral antiviral therapy on survival in this population is not known. We evaluated the impact of oral antivirals on survival of HBV-infected haemodialysis patients. METHOD: This retrospective study included 52 HBsAg-positive haemodialysis patients and 156 non-infected haemodialysis controls. Criteria adopted for starting lamivudine were the 2001 American Association for the Study of Liver Diseases guidelines. Lamivudine was commenced in 21 (40.4%) patients, with median treatment duration of 58 months. The primary endpoint was transplant-free survival. RESULTS: Survival of HBsAg-positive patients was equivalent to that of age- and sex-matched HBsAg-negative controls (39.1% vs 33.2% at 10 years, respectively; P=0.12). In treated patients, complete viral suppression was associated with improved survival (serial HBV DNA less than and equal to 2 log10 IU/mL, 90.9% vs HBV DNA >2 log10 IU/mL on at least one occasion, 74.1% at 5 years; P=0.049). Out of 20 deaths, three were liver-related. CONCLUSION: Haemodialysis patients with chronic HBV, when given oral antiviral therapy if indicated, had equivalent long-term survival to that of non-infected controls. In those with active viral hepatitis, viral suppression was associated with reduced liver-related mortality.

Impaired functional capacity in potential liver transplant candidates predicts short-term mortality before transplantation.

Liver transplantation (LT) is a lifesaving treatment. Because of the shortage of donor organs, some patients will not survive long enough to receive a transplant. The identification of LT candidates at increased risk of short-term mortality without transplantation may affect listing decisions. Functional capacity, determined with cardiopulmonary exercise testing (CPET), is a measure of cardiorespiratory reserve and predicts perioperative outcomes. This study examined the association between functional capacity and short-term survival before LT and the potential for CPET to predict 90-day mortality without transplantation. A total of 176 patients who were assessed for nonacute LT underwent CPET. Ninety days after the assessment, 10 of the 164 patients who had not undergone transplantation were deceased (mortality rate = 6.1%). According to a comparison of survivors and nonsurvivors, the Model for End-Stage Liver Disease score, UK Model for End-Stage Liver Disease (UKELD) score, age, anaerobic threshold, and peak oxygen uptake (VO(2)) were significant univariate predictors of 90-day mortality without transplantation, but only the UKELD score and peak VO(2) retained significance in a multivariate analysis. The mean peak VO(2) was significantly lower for nonsurvivors versus survivors (15.2 ± 3.3 versus 21.2 ± 5.3 mL/minute/kg, P < 0.001). According to a receiver operating characteristic (ROC) curve analysis, peak VO(2) performed well as a diagnostic test (area under the ROC curve = 0.84, 95% confidence interval = 0.76-0.92, sensitivity = 0.90, specificity = 0.74, P < 0.001). The optimal cutoff value for predicting mortality was ≤17.6 mL/minute/kg. The positive predictive value of a peak VO(2) ≤ 17.6 mL/minute/kg for 90-day mortality was greatest for patients with high UKELD scores: 38% of the patients with a UKELD score ≥ 57 and a peak VO(2) ≤ 17.6 mL/minute/kg died, whereas only 6% of the patients with a UKELD score ≥ 57 and a peak VO(2) > 17.6 mL/minute/kg died (P = 0.03). In conclusion, patients assessed for LT with an impaired functional capacity have poorer short-term survival; this is particularly true for individuals with worse liver disease severity.