title: Adefovir- or Lamivudine-Induced Renal Tubular Dysfunction after Liver Transplantation.
abstract: To reduce hepatitis B virus reinfection after liver transplantation (LT), patients often receive antihepatitis B immunoglobulin (HBIG) alone or combined with antiviral nucleoside/nucleotide analogs (NUCs); however, proximal renal tubular dysfunction (RTD) that was induced by NUCs in liver recipients was rarely reported. Here, we analyzed RTD and renal impairment (RI) following adefovir (ADV) and lamivudine (LAM) treatment in liver recipients. We retrospectively reviewed medical records of patients treated with HBIG alone (group 1, n = 42) or combined with ADV or LAM (group 2, n = 21) after LT. We compared RTD and RI incidence during the 12 months after LT. An RTD diagnosis required manifestation of at least 3 of the following features: hypophosphatemia, RI, hypouricemia, proteinuria, or glucosuria. No significant differences were observed regarding sex, age, donor type, model of end-stage liver score, and estimated glomerular filtration rate at pre-LT between the 2 groups. Hepatitis B virus recurrence within 12 months was 4.8% in both groups (P = 1.000); however, the RTD incidence was 0% in group 1 and 19.0% in group 2 (P = 0.010). RI occurrence did not differ between the groups. The only risk factor for RI was HBIG administration combined with both LAM and ADV (odds ratio 11.27, 95% confidence interval 1.13-112.07, P = 0.039, vs HBIG alone). RTD occurred more frequently in patients treated with HBIG combined with LAM or ADV compared with HBIG alone. Thus, LAM or ADV therapy can induce RTD after LT, and when administered, liver recipients should be monitored.
authors.affiliation: From the Yonsei University College of Medicine, Seoul (JGL, JL, SHS, MKJ, GHC, MSK, JSC, SIK, DJJ), Department of Surgery, CHA Bundang Medical Center, CHA University, Bundang (JJL); and The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea (JGL, MSK, SIK, DJJ).
authors.forename: Jae Geun
authors.initials: JG
authors.lastname: Lee
authors.forename: Juhan
authors.initials: J
authors.lastname: Lee
authors.forename: Jung Jun
authors.initials: JJ
authors.lastname: Lee
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Song
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Ju
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Joo
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000401:mortality; D019259:Lamivudine / Q000009:adverse effects; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000401:mortality; D012008:Recurrence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; C053001:adefovir; D000225:Adenine