Real World Efficacy and Safety of Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Liver Transplant Recipients.

BACKGROUND

The efficacy and safety of nucleos(t)ide analogs is currently a critical issue in the treatment of hepatitis B virus infection. We aimed to investigate the long-term efficacy and safety profile of tenofovir alafenamide (TAF) treatment in the liver transplant recipients (LTRs).

METHODS

This retrospective study was conducted with 72 LTRs who received TAF as sequential therapy after tenofovir disoproxil fumarate (TDF). The renal, metabolic outcomes, and efficacy of TAF were evaluated. In addition, some parameters were evaluated separately according to the use of calcineurin inhibitors.

RESULTS

Following TAF treatment, median serum phosphorus levels and estimated glomerular filtration rate (eGFR) increased significantly in the overall cohort (from 2.4 to 2.85 mg/dL [p < 0.001]; from 66 to 74 mL/min/1.73 m2 [p = 0.028], respectively). These improvements were more pronounced in patients with baseline hypophosphatemia and reduced eGFR. However, no significant changes were observed in eGFR staging. A categorical worsening of lipid profile was noted based on the NCEP ATP-III criteria, with increases in some lipid parameters. No significant weight gain or increase in the incidence of posttransplant diabetes mellitus was observed. Antiviral efficacy was maintained following the switch from TDF to TAF. In addition, no significant changes in immunosuppressive drug dosing were required, and no adverse events related to TAF were reported.

CONCLUSION

TAF was well-tolerated and effective in LTRs. The long-term benefits of TAF on hypophosphatemia, renal function, and effective viral suppression were demonstrated. The patients with an increased risk of cardiovascular disease should receive more intensive monitoring for changes in their lipid profile.