Tenofovir-associated Fanconi syndrome in liver transplant recipients with hepatitis B: A retrospective case series

Tenofovir-associated Fanconi syndrome (TAFS) is a proximal renal tubule disorder rarely reported in patients after liver transplantation (LT) for hepatitis B (HBV). In a retrospective review of 79 HBV-LT recipients, 8/66 (12.1%) on tenofovir post-LT developed TAFS. Primary laboratory findings were hypophosphatemia (100%) and proteinuria (87.5%). No patients required renal replacement therapy or died from TAFS. The majority (85.7%) of surviving patients achieved tubular recovery after stopping tenofovir (mean: 13 weeks). In conclusion, TAFS is likely underdiagnosed in LT recipients. Regular screening for hypophosphatemia, proteinuria, and glucosuria is recommended for HBV-LT recipients on tenofovir, as most responded well to discontinuation.