Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2018; 10(2): 337-346
Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.337
Outcomes of kidney transplantation in patients with hepatitis B virus infection: A systematic review and meta-analysis
Charat Thongprayoon, Wisit Kaewput, Konika Sharma, Karn Wijarnpreecha, Napat Leeaphorn, Patompong Ungprasert, Ankit Sakhuja, Franco H Cabeza Rivera, Wisit Cheungpasitporn
Charat Thongprayoon, Konika Sharma, Karn wijarnpreecha, Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, United States
Wisit Kaewput, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Napat Leeaphorn, Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Patompong Ungprasert, Clinical Epidemiology Unit, Department of Research and development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Ankit Sakhuja, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Franco H Cabeza Rivera, Wisit Cheungpasitporn, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Thongprayoon C, Kaewput W, Sharma K and Leeaphorn N collected the data; Thongprayoon C analyzed the data; Thongprayoon C, Sharma K, Wijarnpreecha K, Leeaphorn N, Ungprasert P, Sakhuja A and Cabeza Rivera FH interpreted the data; Thongprayoon C and Kaewput W drafted the article; Wijarnpreecha K, Ungprasert P, Sakhuja A and Cabeza Rivera FH revised the article; Cheungpasitporn W made the conception and design of the study, and critically revised the article; all the authors made the final approval of the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Wisit Cheungpasitporn, MD, Assistant Professor, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, 2500 N. State St., Jackson, MS 39216, United States.
Telephone: +1-518-2589978 Fax: +1-601-9845765
Received: November 28, 2017
Peer-review started: November 28, 2017
First decision: December 18, 2017
Revised: January 10, 2018
Accepted: February 5, 2018
Article in press: February 5, 2018
Published online: February 27, 2018

To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus (HBV) infection, and the trends of patient’s outcomes overtime.


A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios (OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen (HBsAg) positive] were included. The comparison group consisted of HBsAg-negative kidney transplant recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017080657).


Ten observational studies with a total of 87623 kidney transplant patients were enrolled. Compared to HBsAg-negative recipients, HBsAg-positive status was significantly associated with increased risk of mortality after kidney transplantation (pooled OR = 2.48; 95%CI: 1.61-3.83). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBsAg-positive recipients and year of study (slopes = -0.062, P = 0.001). HBsAg-positive status was also associated with increased risk of renal allograft failure with pooled OR of 1.46 (95%CI: 1.08-1.96). There was also a significant negative correlation between year of study and risk of allograft failure (slopes = -0.018, P = 0.002). These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients. We found no publication bias as assessed by the funnel plots and Egger’s regression asymmetry test with P = 0.18 and 0.13 for the risks of mortality and allograft failure after kidney transplantation in HBsAg-positive recipients, respectively.


Among kidney transplant patients, there are significant associations between HBsAg-positive status and poor outcomes including mortality and allograft failure. However, there are potential improvements in patient and graft survivals in HBsAg-positive recipients overtime.

Keywords: Hepatitis B, Kidney transplant, Kidney, Renal transplantation, Transplantation, Meta-analysis

Core tip: Hepatitis B is one of the most common infectious diseases worldwide. Despite advances in medicine, chronic hepatitis B virus (HBV) infection is currently incurable. In addition, clinical outcomes of kidney transplantation in HBV infected patients are still unclear. To further assess these outcomes, we conducted this systematic review and meta-analysis to assess patient and allograft outcomes after kidney transplantation in patients with HBV Infection. We found significant associations between HBV positive status and poor outcomes including 2.5-fold increased risk of mortality and 1.5-fold increased risk of allograft loss.