Comparative analysis of tenofovir alafenamide and entecavir on renal function and serum lipids in liver transplant recipients: a controlled retrospective cohort study

Antiviral treatments can impact serum lipids as well as kidney function. We conducted a retrospective observational study with a 48-month follow-up period, involving liver transplant recipients receiving either entecavir or tenofovir alafenamide, to assess the effects of these antiviral medications on serum lipids and renal function. The study was conducted with 47 patients. Research data were retrospectively collected. Serum creatinine and lipid levels were measured at least once per year for each patient. The Friedman test was applied to compare estimated glomerular filtration rate (eGFR) and serum lipids. . During the 48-month observation period, a mean decrease in eGFR of 10 mL/min/1.73 m² was observed in the tenofovir alafenamide treatment group (p < 0.001), while a decrease of 8 mL/min/1.73 m² occurred in the entecavir group (p < 0.001). However, there was no statistically significant difference in the eGFR decrease between the two groups (p = 0.990). Although entecavir showed more favorable effects on total cholesterol compared to tenofovir alafenamide at the 12th and 24th months (p = 0.025 and p = 0.023, respectively), neither treatment demonstrated a lipid-lowering effect by the end of the 48-month observation period. We found no significant difference in renal safety between tenofovir alafenamide and entecavir; however, the relatively small sample size and retrospective design limit the power to detect subtle differences. Entecavir was associated with a more favorable lipid profile compared to tenofovir alafenamide during the first two years of treatment, with modest reductions in total cholesterol observed at 12 and 24 months. Overall, both entecavir and tenofovir alafenamide have similar impacts on serum lipids and renal function, making them safe and effective treatment options for liver transplant recipients.