Saifu Yin , Xiaoting Chen , Xingxing Li , Fan Zhang , Jiapei Wu , Tao Lin
{"title":"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","authors":"Saifu Yin , Xiaoting Chen , Xingxing Li , Fan Zhang , Jiapei Wu , Tao Lin","doi":"10.1016/j.trre.2024.100840","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Thirteen studies were included for the final analysis. The DNH incidence was at 0.36% (9/2516) with low heterogeneity (I<sup>2</sup> = 6%). HBsAb+ recipients (OR: 0.78, 95%CI: 0.25–2.38), HBcAb+ recipients (OR: 3.11, 95%CI: 0.91–10.66, <em>P</em> = 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, <em>P</em> = 0.55) and patient survival (HR:1.16, 95%CI: 0.98–1.38, <em>P</em> = 0.090) compared with recipients receiving HBcAb- kidneys.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"38 2","pages":"Article 100840"},"PeriodicalIF":3.6000,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Was antiviral prophylaxis necessary after kidney transplantation utilizing HBcAb+ donors? A systematic review and meta-analysis\",\"authors\":\"Saifu Yin , Xiaoting Chen , Xingxing Li , Fan Zhang , Jiapei Wu , Tao Lin\",\"doi\":\"10.1016/j.trre.2024.100840\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Thirteen studies were included for the final analysis. The DNH incidence was at 0.36% (9/2516) with low heterogeneity (I<sup>2</sup> = 6%). HBsAb+ recipients (OR: 0.78, 95%CI: 0.25–2.38), HBcAb+ recipients (OR: 3.11, 95%CI: 0.91–10.66, <em>P</em> = 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, <em>P</em> = 0.55) and patient survival (HR:1.16, 95%CI: 0.98–1.38, <em>P</em> = 0.090) compared with recipients receiving HBcAb- kidneys.</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":48973,\"journal\":{\"name\":\"Transplantation Reviews\",\"volume\":\"38 2\",\"pages\":\"Article 100840\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-03-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation Reviews\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0955470X24000235\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Reviews","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0955470X24000235","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Was antiviral prophylaxis necessary after kidney transplantation utilizing HBcAb+ donors? A systematic review and meta-analysis
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.
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.
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