Naslov
Renal safety of nucleos(t)ide analogue monotherapy in HBV-exposed patients after liver transplantation

Autori
Mrzljak, Anna ; Carey, Ivana ; Knighton, Sarah ; Bruce, Matthew J ; Horner, Mary ; Considine, Aisling B ; Aluvihare, Varuna ; O’Grady, John G ; Heneghan, Michael A ; Agarwal, Kosh ; Suddle, Abid

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Hepatology / Nathanson, Michael - : John Wiley & Sons, 2015, 1058A-1058A

Skup
The 66th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2015

Mjesto i datum
San Francisco (CA), Sjedinjene Američke Države, 13.11.2015. - 17.11.2015

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
nucleos(t)ide ; HBV ; liver transplantation ; kidney

Sažetak
Switch from long-term hepatitis B immunoglobulin (HBIg) prophylaxis in combination with lamivudine (LAM) to nucelos(t)ide analogue (NA) monotherapy achieves efficient viral control, but long-term renal safety might be a concern in HBV-exposed patients post-liver transplantation (LTx). Changes in estimated glomerular filtration (eGFR) represent late marker of renal toxicity, however early biomarkers, such as cystatin C (glomerular function) and lipocalin (NGAL) (tubular function) allow earlier diagnosis. Aim: Retrospective cross-sectional single centre study to determine wheather cystatin C and NGAL on- therapy plasma levels can predict early renal toxicity in HBV- exposed patients post-LTx on long-term tenofovir (TDF) or entecavir (ETV) (median duration 4 years) after switching from LAM+HBIg (median 6.2 years after LTx). Patients: 47 patients (39 males, median age 59 years) post-LTx due to HBV were switched from LAM+HBIg to TDF (n=26) or ETV (n=21) and followed for median 4 years. Methods: Differences between eGFR and plasma phosphate (PO4) levels were compared 1 year before switch, at switch and then yearly after switch. Cystatin C and NGAL plasma levels were measured at same time-points by ELISA. Patients were stratified according to pre-existing renal risks (RR) (hypertension, diabetes, diuretics, pre- exisiting renal dysfunction) and therapeutic regimens. Results are presented as medians. Results: 55% patients had renal risk ; 20 hypertension, 14 diabetes, 4 therapy with diuretics and 9 patients had pre-existing renal impairment. 38% patients had eGFR<60 at baseline and this proportion increased in the first 2 years after switch to 51% and 50% respectively (p<0.05). Overall eGFR was similar at all time- points, but declined significantly only in RR patients after 2 years on NA (switch: 58 vs. year1: 56 vs. year2: 51 vs. year3: 51 and year4: 53ml/min, p=0.04). As ETV was preferentialy used in RR patients eGFR was lower at switch and during therapy in patients on ETV than TDF. Phosphate levels gradually declined in all patients after 3 years (switch: 0.98 vs. year3: 0.88, p=0.02). Cystatin C levels increased in all patients after 2 years post-switch (switch: 1.51 vs. year2: 1.71 mg/l, p<0.05). NGAL increased after 1st year post-switch in all patients (switch: 54 vs. year1: 63 ng/ml, p<0.05) Conclusions: Overall eGFR did not change and was only declining in patients with renal risks after switching from LAM+HBIg to NA monotherapy. Early markers of renal dysfunction cystatin C and NGAL had increased in relation to NA therapy in all patients. Cystatin C and NGAL may enable safe delivery of long-term NA therapy in patients post-liver transplant.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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