Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.337
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
Among renal transplant patients with hepatitis B virus (HBV) (HBsAg positive), there have been reported cases of HBV reactivation, massive liver necrosis due to fulminant hepatitis, and severe cholestatic hepatitis after kidney transplantation. In spite of improvement of HBV care, the outcomes of kidney transplantation including patient and allograft outcomes in recipients with HBV infection remain unclear.
Although hepatitis B is still incurable, there have been significant advancements in antiviral agents resulting in reasonably sustained suppression of HBV replication after kidney transplantation. The results of studies on kidney transplant outcomes in patients with renal transplant patients with HBV (HBsAg positive) were inconsistent. To further investigate outcomes of renal transplant patients with HBsAg positivity, the authors conducted this systematic review and meta-analysis reporting the association between HBsAg positivity in kidney transplant recipients and higher risks of mortality and allograft failure after kidney transplantation.
We conducted this meta-analysis to assess the outcomes of kidney transplantation including patient and allograft outcomes in recipients with HBV infection; and the trends of patient’s outcomes overtime.
A literature search was conducted using databases (MEDLINE, EMBASE and Cochrane Database) from inception through October 2017. Those studies reported odds ratios (OR) of mortality or renal allograft failure after kidney transplantation in HBV patients (defined as HBsAg positive) were included. HBsAg-negative kidney transplant recipients are the comparison group. The effect estimates from the individual study were extracted and combined.
The authors demonstrated that HBsAg-positive status in kidney transplant recipients was significantly associated with poor outcomes after transplantation. These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients.
The authors found significant associations of HBsAg positive status with poor outcomes after transplantation. Significant negative correlations between the risks of mortality and allograft failure and year of study, representing potential improvements in patient and graft survivals overtime were found.
This study demonstrated significantly increased risks of mortality and allograft failure in HBsAg-positive kidney transplant recipients. This finding suggests that HBsAg positive status may be an independent potential risk factor for poor outcomes after transplantation. However, there are also potential improvements in patient and graft survivals with HBV infection overtime.