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Review
. 2023 Feb 17;12(2):340.
doi: 10.3390/pathogens12020340.

The Impact of Antiviral Treatment of Hepatitis B Virus after Kidney Transplant and the Latest Insights

Fabrizio Fabrizi  1 , Maria Francesca Donato  2 , Federica Tripodi  1 , Anna Regalia  1 , Pietro Lampertico  2   3 , Giuseppe Castellano  1   3
Affiliations
Review

The Impact of Antiviral Treatment of Hepatitis B Virus after Kidney Transplant and the Latest Insights

Fabrizio Fabrizi et al. Pathogens. .

Abstract

Background: The current frequency of hepatitis B virus infection in patients with advanced chronic kidney disease (CKD) (including patients on maintenance dialysis and kidney transplant recipients) is low but not negligible worldwide. HBV has a deleterious effect on survival after a kidney transplant; antiviral treatments improved the short-term outcomes of kidney transplant recipients, but their long-term impact remains uncertain.

Aim: The aim of this review is to assess the role of antiviral therapy for HBV in improving survival after a kidney transplant. The recent publication of large surveys has prompted us to update the available evidence on the impact of HBV on patient and graft survival after a kidney transplant.

Methods: We have conducted an extensive review of the medical literature, and various research engines have been used.

Results: We retrieved several studies (n = 11; n = 121,436 unique patients) and found an association between positive serologic HBsAg status and diminished patient and graft survival after a kidney transplant; the adjusted relative risk (aRR) of all-cause mortality and graft loss was 2.85 (95% CI, 2.36; 3.33, p < 0.0001) and 1.26 (95% CI, 1.02; 1.51, p < 0.0001), respectively. To our knowledge, at least six studies reported improved patient and graft survival after the adoption of antiviral therapies for HBV (this result was reported with both survival curves and multivariable regression). According to novel clinical guidelines, entecavir has been suggested as a 'first line' antiviral agent for the treatment of HBV after a kidney transplant.

Conclusions: The recent availability of safe and effective antiviral drugs for the treatment of HBV has meant that the survival curves of HBsAg-positive patients on antiviral therapy and HBsAg-negative patients after a kidney transplant can be comparable. Antiviral therapy should be systematically proposed to HBV-positive kidney transplant recipients and candidates to avoid the deleterious hepatic and extra-hepatic effects of chronic HBV replication.

Keywords: hepatitis B virus; kidney transplantation; nucleos(t)ide analogues; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot: impact of HBV infection on all-cause mortality after kidney transplant [10,12,14,26,27,28,29,30,31,32,33].
Figure 2
Figure 2
Funnel plot: HBV and patient survival after kidney transplant.
Figure 3
Figure 3
HBsAg-seropositive status and patient survival: aRR of all-cause death (according to fixed- and random-effects model). * RR pooled fixed effects; ** RR pooled random effects.
Figure 4
Figure 4
Forest plot: impact of HBV infection on all-cause graft loss after kidney transplant [10,12,14,26,27,29,30,32,33,34,35].
Figure 5
Figure 5
Odd Man Out: HBsAg-seropositive status and all-cause graft loss: aRR of graft loss and 95% CI (individual studies). Vertical bars indicate the 95 percent confidence intervals (95% CIs) for the relative risk of graft loss after kidney transplant (in each study) according to HBsAg-seropositive status. The shaded region indicates the portions of the RR of the graft loss axis included in the eleven study-specific 95% CIs.
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