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

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.