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Tenofovir alafenamide prophylaxis post-liver transplantation: a real-world study in patients with chronic kidney disease

Journal Volume 85 - 2022
Issue Fasc.2 - Original articles
Author(s) E. Sinakos 1, P. Panas 1, N. Fragkou 1, N. Antoniadis 2, G. Katsanos 2, E. Tsakni 2, T. Oikonomou 1, A. Notopoulos 3, G. Tsoulfas 2, I. Goulis 1, E. Akriviadis 1
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Full Article
PAGES 331-337
(1) 4th Medical Department, Hippokratio Hospital, Aristotle University of Thessaloniki, Greece
(2) Department of Transplant Surgery, Hippokratio Hospital, Aristotle University of Thessaloniki, Greece
(3) Department of Nuclear Medicine, Hippokratio Hospital, Thessaloniki, Greece

Background & aims: Tenofovir alafenamide fumarate (TAF) was shown equally efficacious in suppressing hepatitis B virus (HBV) but with less renal toxicity than tenofovir disoproxil fumarate (TDF). The aim of this real-world study was to evaluate renal function in post-liver transplantation (LT) patients that changed TDF with TAF.

Methods: The TAF group (n=17) included patients who switched to TAF due to low (<60 ml/min/1.73m2) Glomerular Filtration Rate (GFR). The control group included patients that remained on TDF (n=30), although some (n= 14) had chronic kidney disease (CKD) (TDF-CKD group). GFR was assessed using: i) MDRD-6 variable; ii) CKD-EPI formula; iii) radionuclide technique (rGFR).

Results: There were no significant differences between the two groups except for the presence of diabetes and follow-up period, which were more common and shorter, respectively, in the TAF group (35% vs. 10%, p=0.03; 13.7 vs. 35.5 months, p<0.001). At the end of follow-up there were no significant changes in renal function between the TAF and the TDF group or TDF-CKD group, although the numerical change in rGFR in the latter comparison was greater in the TAF group (ΔrGFR 3 vs. -2.14 ml/min, p=0.26). The use of everolimus was associated with improvement in renal function (ΔrGFR 2 vs. -7.75 ml/min, p=0.06 [TAF vs. TDF group]; 2 vs. -12 ml/min, p=0.01 [TAF vs. TDF-CKD group]). There were no TAF- related side effects or cases of HBV recurrence.

Conclusion: Conversion to TAF in post-LT patients who develop CKD does not lead to improvement of kidney function after a period of one year.

Keywords: tenofovir alafenamide, liver transplantation, chronic kidney disease, prophylaxis, hepatitis B.

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PMID 35709777