Meta-Analysis
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: http://creativecommons.org/licenses/by-nc/4.0/
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. wcheungpasitporn@gmail.com
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
Processing time: 96 Days and 4.6 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.