Nephrology · 5 h ago
HBV-Positive Donor Kidneys Show Comparable Survival in Meta-Analysis
A systematic review and meta-analysis included 11 studies of kidney transplant recipients receiving kidneys from hepatitis B virus (HBV)-positive donors; six studies contributed to survival comparisons. Survival was comparable with recipients of HBV-negative kidneys, while reported HBV transmission was 4.94%.
- Six studies contributed to survival meta-analysis.
- Survival was comparable through five years.
- Reported HBV transmission rate was 4.94%.
- Prophylaxis and pretransplant immunity were associated with lower transmission.
This systematic review and meta-analysis assessed transplantation of kidneys from hepatitis B surface antigen-positive or viremic donors into non-viremic kidney transplant recipients. The authors searched PubMed and Embase through November 2025. Eleven studies were included in the review and six in the meta-analysis, covering 638 recipients of HBV-positive kidneys and 2,800 recipients of HBV-negative kidneys. Outcomes included patient and allograft survival at one, three, and five years, as well as reported HBV transmission.
Allograft survival did not differ statistically between groups at one year (risk ratio [RR], 1.00; 95% CI, 0.98–1.01), three years (RR, 1.01; 95% CI, 0.98–1.04), or five years (RR, 1.00; 95% CI, 0.91–1.09). Patient survival was also reported as comparable. The review found a 4.94% rate of HBV transmission, with lower rates reported when prophylaxis was used and recipients were immune before transplantation.
The findings suggest HBV-positive kidneys may help expand the donor pool for immune recipients when appropriate prophylaxis is used. However, the evidence is drawn from a limited number of studies, and the abstract does not provide further details on study quality or prophylaxis regimens; the results do not establish a universal transplant approach.
In practice
For kidney transplant teams considering organs from HBV-positive or viremic donors, this review reports comparable patient and allograft survival versus HBV-negative donor kidneys and a 4.94% reported HBV transmission rate. Transmission was reported to be lower with prophylaxis and pretransplant recipient immunity. These findings may support consideration of such kidneys to expand the donor pool in appropriately selected, immune recipients, but the evidence comes from only 11 studies, with six contributing to pooled survival analyses; the abstract does not detail study quality or prophylaxis regimens. It does not establish a universal protocol or justify changes without local clinical assessment.
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Clinical Transplantation: Transplantation of Hepatitis B Surface Antigen Positive or Viremic Kidneys: A Systematic Review and Meta‐Analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.