Comparing Long-Term Outcomes of Entecavir and Tenofovir Disoproxil Fumarate in Liver Transplant Patients

Objectives. There are no detailed reports on the long-term outcome of patients treated with tenofovir disoproxil fumarate (TDF) compared with entecavir (ENT) following liver transplantation. We aimed to assess the association between TDF use and long-term outcome compared to recipients using ENT. Methods. This retrospective observational study included patients who underwent liver transplantation between January 2015 and May 2019 at the First Affiliated Hospital of Zhejiang University School of Medicine and Hangzhou Shulan Hospital. Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were performed to assess HBV recurrence, renal dysfunction, and patient survival in liver transplant patients treated with TDF compared with ENT. Results. A total of 907 patients met the inclusion criteria and were included in the final analysis, among which, there were 109 (12.0%) patients treated with TDF and 798 (88.0%) patients treated with ENT. During the follow-up period, 166 patients died, 15 (13.8%) in the TDF group, and 151 (18.9%) in the ENT group. No significant association was found between TDF or ENT use and patient survival (HR, 0.72, 95% CI 0.41-1.23; 
 
 P
 =
 0.226
 
 ) by PSM analysis. Similarly, differences in the antiviral agents were not significantly associated with hepatitis B recurrence (HR, 1.19, 95% CI 0.62-2.28; 
 
 P
 =
 0.603
 
 ), but TDF use was significantly related to renal dysfunction after liver transplantation (HR 1.70, 95% CI, 1.21-2.37; 
 
 P
 =
 0.002
 
 ). Similar results were obtained in subsequent sensitivity analyses. Conclusions. In this study, the results showed that the use of TDF after liver transplantation is as safe and effective as the use of ENT in preventing hepatitis B recurrence. However, renal function in recipients treated with TDF requires careful monitoring.