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

doi:10.4254/wjh.v10.i2.337

Outcomes of kidney transplantation in patients with hepatitis B virus infection: A systematic review and meta-analysis

World J Hepatol. 2018 Feb 27;10(2):337-346. doi: 10.4254/wjh.v10.i2.337.

Authors

Charat Thongprayoon¹, Wisit Kaewput², Konika Sharma¹, Karn Wijarnpreecha, Napat Leeaphorn³, Patompong Ungprasert⁴, Ankit Sakhuja⁵, Franco H Cabeza Rivera⁶, Wisit Cheungpasitporn⁶

Affiliations

¹ Karn wijarnpreecha, Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, United States.
² Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
³ Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.
⁴ Clinical Epidemiology Unit, Department of Research and development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States.
⁶ Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States.

Abstract

Aim: 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.

Methods: 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).

Results: 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.

Conclusion: 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; Kidney transplant; Meta-analysis; Renal transplantation; Transplantation.