Hepatitis B and survival after renal transplant: Meta-analysis of observational studies

F. Fabrizi, V. Dixit, P. Martin, P. Messa

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5 Scopus citations


Recent evidence has been accumulated suggesting that HBsAg seropositive status is significantly linked to lower patient and graft survival after renal transplant even if conflicting data on this point exist. The aim of this study was to conduct a systematic review of the published medical literature concerning the impact of HBV surface antigen seropositive status on all-cause mortality and graft loss after RT. The relative risk of all-cause mortality and graft loss was regarded as the most reliable outcome end-point. Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effect pooled estimates for mortality and graft loss with HBsAg across the published studies. We identified ten observational studies involving 82 690 unique renal transplant recipients. The summary estimate for adjusted relative risk (aRR) of all-cause mortality was 2.214 with a 95% confidence interval (CI) of 1.56; 3.137 (P < 0.0001); heterogeneity statistics, Ri = 0.98 (P-value by Q-test = 0.0001). The overall estimate for adjusted RR of all-cause graft loss was 1.44 (95% CI, 1.26; 1.63) (P < 0.0001) and heterogeneity statistics, Ri = 0.05 (P-value by Q-test = 0.4). Stratified analysis changed marginally the results. Meta-regression showed that diabetes mellitus had a detrimental role on patient survival (P = 0.02). This meta-analysis of observational studies supports the notion that HBsAg-positive patients after RT have an increased risk of mortality and graft loss. The mechanisms underlying the relationship between HBsAg and mortality or graft dysfunction after renal transplant are an area of avid research.

Original languageEnglish
Pages (from-to)542-550
Number of pages9
JournalJournal of Viral Hepatitis
Issue number8
StatePublished - Aug 2014
Externally publishedYes


  • Hepatitis B
  • graft loss
  • liver disease
  • renal transplant
  • survival


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