背景:目前的指南缺乏关于HBcAb+供体肾移植后是否应给予抗病毒prophylaxes的共识。本系统评价和荟萃分析旨在评估新发HBV(DNH)感染的发生率和危险因素,以及移植和病人的生存。
方法:我们搜索了PubMed,Embase,以及截至2023年12月31日的Cochrane图书馆。我们纳入了使用HBcAb+肾脏移植后评估临床结果的相关研究。患病率的效果汇总指标和95%置信区间(CI),危险因素,使用随机效应荟萃分析评估移植物和患者的存活率.
结果:最终分析包括13项研究。DNH发生率为0.36%(9/2516),异质性低(I2=6%)。HBsAb+接受者(OR:0.78,95CI:0.25-2.38),HBcAb+接受者(OR:3.11,95CI:0.91-10.66,P=0.071),和未接受任何抗病毒预防的受者(OR:1.26,95CI:0.15-10.58)与较高的DNH风险无关.具体来说,HBsAb-/HBcAb+接受者的DNH发生率最高(4.65%),其次是HBsAb-/HBcAb-(0.49%),HBsAb+/HBcAb-接受者(0.45%),和HBsAb+/HBcAb+(0%)。此外,与接受HBcAb+肾脏的受者相比,接受HBcAb+肾脏的受者具有相当的移植物存活率(HR:1.06,95CI:0.94-1.19,P=0.55)和患者存活率(HR:1.16,95CI:0.98-1.38,P=0.090).
结论:利用HBcAb+肾脏的肾移植有助于相当的移植物和患者生存,HBV传播的风险极低。抗病毒药物只能在HBsAb-/HBcAb+接受者中施用。
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.
CONCLUSIONS: 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.