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

 Juhan Lee  ;  Jae Geun Lee  ;  Shin Hwang  ;  Kwang-Woong Lee  ;  Jong Man Kim  ;  Je Ho Ryu  ;  Bong-Wan Kim  ;  Dong Lak Choi  ;  Young Kyoung You  ;  Dong-Sik Kim  ;  Yang Won Nah  ;  Koo Jeong Kang  ;  Jai Young Cho  ;  Hee Chul Yu  ;  Geun Hong  ;  Dongho Choi  ;  Ju Ik Moon  ;  Myoung Soo Kim 
 HEPATOLOGY INTERNATIONAL, Vol.16(3) : 537-544, 2022-06 
Journal Title
Issue Date
Adult ; Antiviral Agents / adverse effects ; Guanine / analogs & derivatives ; Hepatitis B virus ; Hepatitis B, Chronic* ; Humans ; Kidney / physiology ; Kidney Diseases* / chemically induced ; Kidney Diseases* / complications ; Kidney Diseases* / drug therapy ; Liver Transplantation* ; Registries ; Republic of Korea / epidemiology ; Retrospective Studies ; Tenofovir / adverse effects ; Treatment Outcome
Entecavir ; Hepatitis B virus ; Liver transplantation ; Renal dysfunction ; Tenofovir
Background and aims: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been recommended after liver transplantation to prevent recurrence of hepatitis B virus infection. Despite its proven efficacy, the renal safety of TDF has not been established in liver transplant recipients. We aimed to compare the effects of TDF and ETV on renal function in liver transplant recipients and to evaluate risk factors for renal dysfunction after liver transplantation.

Methods: This is a retrospective, observational multicenter study of data from the Korean Organ Transplantation Registry. We included adults who underwent liver transplantation for hepatitis B virus-related complications from April 2014 to December 2017 and received TDF or ETV post-transplantation. Renal dysfunction was defined as an estimated glomerular filtration rate decline by at least 20% from baseline (1 month post-transplantation). Median duration of follow-up was 29 months (interquartile range 19-42).

Results: A total of 804 liver transplant patients were included. The cumulative probability of renal dysfunction was significantly higher in the TDF group than in the ETV group. Multivariable analysis confirmed that TDF was independently associated with an increased risk of renal dysfunction (hazard ratio = 1.47, 95% confidence interval 1.12-1.92; p = 0.005). Independent risk factors for renal dysfunction included older age, worse baseline renal function, and low body mass index. Overall survival rate was significantly lower in patients with renal dysfunction than in those without.

Conclusions: In this nationwide study, the use of TDF was associated with an increased risk of renal dysfunction, when compared with ETV.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Lee, Ju Han(이주한)
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