BACKGROUND: An association between HBsAg seropositive status and increased mortality after kidney transplantation has been demonstrated in previous studies over the past decade. Although chronic hepatitis B virus (HBV) infection is currently still incurable, there have been significant advancements in antiviral agents resulting in reasonably sustained suppression of HBV replication. This meta-analysis aimed to assess 1) outcomes of kidney transplantation including patient and allograft outcomes in recipients with HBV, and 2) trends of patient's outcomes over time.

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 allograft failure after kidney transplantation in patients with HBV (defined as HBsAg positive) were included. The comparison group consisted of HBsAg-negative recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.

RESULTS: 9 observational studies with 11,942 kidney transplant patients were enrolled. Compared to HBsAg-negative recipients, HBsAg-positive status was significantly associated with increased risk of mortality (pooled OR 2.73; 95%CI 1.92-3.89). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBsAg-positive recipients and year of study (slopes[thinsp]=[thinsp]-0.047, p[thinsp]<0.001). HBsAg-positive status was also associated with increased risk of renal allograft failure with pooled OR of 1.57 (95%CI 1.12-2.20). There was also a significant negative correlation between year of study and risk of allograft failure (slopes[thinsp]=[thinsp]-0.015, p[thinsp]<0.001). These associations existed in overall analysis as well as in limited cohort of HCV-negative patients.

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 over time.

CITATION INFORMATION: Leeaphorn N., Thongprayoon C., Sharma K., Sakhuja A., Cheungpasitporn W. Impacts of HBsAg Seropositive Status on Patient and Graft Survival after Kidney Transplantation in the Era of New Antiviral Therapy: A Meta-Analysis Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress