Renal function between Tenofovir and Entecavir in post-liver transplanted hepatitis B patients.

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Introduction: Tenofovir, Nucleotide analogue polymerase inhibitor is already accepted as effective and tolerable drug for treatment of hepatitis B virus (HBV) as much as entecavir. There are some concerns about nephrotoxicity of tenofovir in patients with end-stage liver disease or liver recipients. We retrospectively investigated the renal function of tenofovir compare to entecavir in liver recipients with HBV. Method: Among 468 patients with HBV who were underwent liver transplantation at Samsung Medical Center between 2008 January to 2015 December, tenofovir (n=37) treated group was matched with entecavir (n=132) group. (1:4, matching variables=age, pre-operative HBV DNA, eGFR, CTP score) Baseline characteristics and 1, 2, 3 year follow up eGFR & creatinine levels after operation were compared between both group using GEE(Generalized estimating equation) analysis. Risk factors lowering eGFR value are also reviewed with univariate & multivariate analysis. Result: Among baseline characteristics, age, pre-operative creatinine, eGFR and hepatic encephalopathy score showed statistical difference between tenofovir (n=39) and entecavir (n=429) group before propensity score matching. After matching, there was no statistical difference in pre-operative characteristics. Post-operative 1-year eGFR showed no statistical difference from pre-operative eGFR in both group. Post-operative 2-year eGFR (5.25 ml/min/1.73m2 decrease, p=0.04) and 3-year eGFR (7.43ml/min/1.73m2 decreased, p=0.02) showed a little decreased from pre-operative eGFR, but there was no statistical difference and interaction between tenofovir and entecavir group (p=0.42). Post-operative 1-year creatinine (0.28mg/dl decreased, p=0.02) and 2-year creatinine (0.24mg/dl decreased, p=0.049) showed improvement. 3-year creatinine showed decrease by 20mg/dl without statistical difference (p=0.10) from pre-operative creatinine. There was also no statistical difference and interaction between both group (p=0.38) for creatinine change. Conclusion: Tenofovir does not induce renal dysfunction in liver transplant patients with HBV compared to entecavir. The safety and renal dysfunction in tenofovir after liver transplantation will be investigated in the further studies.