Reappraisal of the Impact of Hepatitis B Virus Serology Positivity On the Outcomes of Kidney Transplantation: A Systematic Review and Meta-Analysis.

Abstract

Background. Organ shortage is a worldwide problem. However, the use of hepatitis B virus (HBV) serology positive donors is still controversial in kidney transplantation (KT). In this study, we conducted a systematic review and meta-analysis which aimed to compare GF rates and mortality rates between kidney transplantation from donors with patients with HBV serology positive and those who received kidneys from HBV serology negative donors. Methods. We searched Medline and Scopus databases published since inception to June 2013 and found 10 studies with 9,905 patients which were eligible for pooling. Eligible studies were cohort studies which studied in adult KT patients and compared GF rates and death rates among recipients who received organ from HBV serology positive donors compared with HBV serology negative donors in parallel design. Either hepatitis core antibody (HBcAb) positive or hepatitis B surface antigen (HBsAg) positive was classified as HBV seropositive. The crude risk ratio (cRR) of GF and death along with its 95% CI was estimated for each study. Results. The pooled risk ratio of GF among all studieswas 1.20 (95% CI: 1.09-1.32), which was significantly higher risk in donors with HBV serology positive. Subgroup analysis was done according to type of serology test. This showed that KT from donor with HBcAb+ had significant higher risk of GF (RR = 1.20, 95%CI: 1.10-1.33). In contrast, GF among recipients who received kidney from HBsAg+ donors was not significantly higher than HBsAg- donors (RR = 0.67, 95%CI: 0.21-2.21). Regarding death outcome, the pooled risk ratio of death among all studieswas 1.25 (95% CI: 1.07-1.45), which significantly higher risk in donors with HBV positive when compared with HBV negative donors. Interestingly, KT from donor with HBcAb+ showed significant higher risk of death (RR = 1.30, 95%CI: 1.12-1.51) but recipients who received kidney from HBsAg+ donors showed lower risk of death (RR = 0.26, 95%CI: 0.07-0.99) when compared with HBV negative donors. Conclusions. This systematic review suggested that KT from HBV serology positive donors seem to have higher risk of GF and death. KT from HBsAg+ donors to anti HBsAb + recipients is not associated with worse outcome when compare with HBsAg- donors.