Was antiviral prophylaxis necessary after kidney transplantation utilizing HBcAb+ donors? A systematic review and meta-analysis

IF 3.6 2区医学 Q2 IMMUNOLOGY Transplantation Reviews Pub Date : 2024-03-12 DOI:10.1016/j.trre.2024.100840

Saifu Yin , Xiaoting Chen , Xingxing Li , Fan Zhang , Jiapei Wu , Tao Lin

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Abstract

Background

Current guidelines lack consensus on whether antiviral prophylaxes should be administered after kidney transplantation from HBcAb+ donors. This systematic review and meta-analysis aimed to evaluate the incidence and risk factors of de novo HBV (DNH) infection, as well as graft and patient survival.

Methods

We searched PubMed, Embase, and the Cochrane Library up to December 31, 2023. We included relevant studies that assessed clinical outcomes following transplantation utilizing HBcAb+ kidneys. Summary measures of effect and 95% confidence intervals (CI) for prevalence, risk factors, as well as graft and patient survival were estimated using random-effects meta-analysis.

Results

Thirteen studies were included for the final analysis. The DNH incidence was at 0.36% (9/2516) with low heterogeneity (I² = 6%). HBsAb+ recipients (OR: 0.78, 95%CI: 0.25–2.38), HBcAb+ recipients (OR: 3.11, 95%CI: 0.91–10.66, P = 0.071), and recipients not receiving any antiviral prophylaxis (OR: 1.26, 95%CI: 0.15–10.58) were not associated with higher DNH risk. Specifically, HBsAb-/HBcAb+ recipients had the highest DNH incidence (4.65%), followed by HBsAb-/HBcAb- (0.49%), HBsAb+/HBcAb- recipients (0.45%), and HBsAb+/HBcAb+ (0%). Furthermore, recipients receiving HBcAb+ kidneys had comparable graft survival (HR: 1.06, 95%CI: 0.94–1.19, P = 0.55) and patient survival (HR:1.16, 95%CI: 0.98–1.38, P = 0.090) compared with recipients receiving HBcAb- kidneys.

Conclusion

Kidney transplantation utilizing HBcAb+ kidneys contributed to comparable graft and patient survival with an extremely low risk of HBV transmission. Antiviral prophylaxes may only be administered in HBsAb-/HBcAb+ recipients.

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利用 HBcAb+ 供体进行肾移植后是否有必要进行抗病毒预防？系统回顾和荟萃分析

背景目前的指南对 HBcAb+ 供体肾移植后是否应进行抗病毒预防缺乏共识。本系统综述和荟萃分析旨在评估新发 HBV（DNH）感染的发生率和风险因素，以及移植物和患者的存活率。方法我们检索了截至 2023 年 12 月 31 日的 PubMed、Embase 和 Cochrane 图书馆。我们纳入了评估使用 HBcAb+ 肾脏进行移植后临床结果的相关研究。采用随机效应荟萃分析法估算了患病率、风险因素以及移植物和患者存活率的效果总结和 95% 置信区间 (CI)。DNH发生率为0.36%（9/2516），异质性较低（I2 = 6%）。HBsAb+受者（OR：0.78，95%CI：0.25-2.38）、HBcAb+受者（OR：3.11，95%CI：0.91-10.66，P = 0.071）和未接受任何抗病毒预防的受者（OR：1.26，95%CI：0.15-10.58）与较高的 DNH 风险无关。具体来说，HBsAb-/HBcAb+受者的 DNH 发生率最高（4.65%），其次是 HBsAb-/HBcAb-（0.49%）、HBsAb+/HBcAb-受者（0.45%）和 HBsAb+/HBcAb+（0%）。此外，与接受 HBcAb- 肾脏的受者相比，接受 HBcAb+ 肾脏的受者的移植物存活率（HR：1.06，95%CI：0.94-1.19，P = 0.55）和患者存活率（HR：1.16，95%CI：0.98-1.38，P = 0.090）相当。只有 HBsAb-/HBcAb+ 受体才可进行抗病毒预防。

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.