Korean J Transplant.  2020 Dec;34(Supple 1):S10. 10.4285/ATW2020.OR-1240.

Renal safety of tenofovir disoproxil fumarate and entecavir in liver transplant patients: a nationwide Korean registry study

• Lee J
• Hwang S
• Lee KW
• Kim JM
• Ryu JH
• Kim BW
• Choi DL
• You YK
• Kim DS
• Kim MS

• KMID: 2509130
• DOI: http://doi.org/10.4285/ATW2020.OR-1240

Abstract

Background
Entecavir and tenofovir are currently the first-line drugs in liver transplantation (LT) patients for the prevention of hepatitis B virus recurrence. Despite its proven efficacy, the renal safety of tenofovir in LT patients has not been well defined. We aimed to assess the impact of tenofovir on renal function compared to that of entecavir after LT.
Methods
We analyzed 817 LT patients treated with entecavir (n=366) or tenofovir (n=451) between 2014 and 2017. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Renal function deterioration was defined as progression of chronic kidney disease stage and ≥20% eGFR decline from 1 month after LT.
Results
Mean eGFR at 1 month after LT was 91.1±22.0 mL/min/1.73 ㎡ for entecavir and 89.1±23.7 mL/min/1.73 ㎡ for tenofovir group (P=0.312). During a median follow-up of 29 months, the cumulative incidence of renal function deterioration was significantly higher in the tenofovir group than in the entecavir group (355.5% vs. 27.1%, P=0.01). Tenofovir (odd ratio [OR], 1.52; 95% confidence interval [CI], 1.11–2.08; P=0.009), old age (OR, 1.45; 95% CI, 1.01–2.09; P=0.044), low body mass index (OR, 2.02; 95% CI, 1.44–2.84; P<0.001), and diabetes mellitus (OR, 1.68; 95% CI, 1.18–2.08; P=0.009) were independent risk factors for renal function deterioration.
Conclusions
The use of tenofovir was significantly associated with renal function deterioration in LT patients. In the setting of LT, tenofovir should be used with caution in high-risk patients and renal function should be carefully monitored.