Outcomes of kidney transplantation in patients with hepatitis B virus infection: A systematic review and meta-analysis

AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios(OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen(HBs Ag) positive] were included. The comparison group consisted of HBs Agnegative kidney transplant recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of Der Simonian and Laird. The protocol for this metaanalysis is registered with PROSPERO(International Prospective Register of Systematic Reviews; no. CRD42017080657).RESULTS Ten observational studies with a total of 87623 kidney transplant patients were enrolled. Compared to HBs Ag-negative recipients, HBs Ag-positive status was significantly associated with increased risk of mortality after kidney transplantation(pooled OR = 2.48; 95%CI: 1.61-3.83). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBs Ag-positive recipients and year of study(slopes =-0.062, P = 0.001). HBs Agpositive status was also associated with increased risk of renal allograft failure with pooled OR of 1.46(95%CI: 1.08-1.96). There was also a significant negative correlation between year of study and risk of allograft failure(slopes =-0.018, P = 0.002). These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients. We found no publication bias as assessed by the funnel plots and Egger's regression asymmetry test with P = 0.18 and 0.13 for the risks of mortality and allograft failure after kidney transplantation in HBs Ag-positive recipients, respectively.CONCLUSION Among kidney transplant patients, there are significant associations between HBs Ag-positive status and poor outcomes including mortality and allograft failure. However, there are potential improvements in patient and graft survivals in HBs Ag-positive recipients overtime.     

Associations of Proton-Pump Inhibitors and H2 Receptor Antagonists with Chronic Kidney Disease: A Meta-Analysis

Background/Aims

The aim of this meta-analysis was to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton-pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs).

Methods

Comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through April 2017 to identify all studies that investigated the risks of CKD or ESRD in patients taking PPIs/H2RAs versus those without PPIs/H2RAs. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this study is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067252).

Results

Five studies with 536,902 participants were patients were identified and included in the data analysis. When compared with non-PPIs users, the pooled risk ratio (RR) of CKD or ESRD in patients with PPI use was 1.33 (95% CI 1.18–1.51). Pre-specified subgroup analysis (stratified by CKD or ESRD status) demonstrated pooled RRs of 1.22 (95% CI 1.14–1.30) for association between PPI use and CKD and 1.88 (95% CI 1.71–2.06) for association between PPI use and ESRD, respectively. However, there was no association between the use of H2RAs and CKD with a pooled RR of 1.02 (95% CI 0.83–1.25). When compared with the use of H2RAs, the pooled RR of CKD in patients with PPI use was 1.29 (95% CI 1.22–1.36).

Conclusions

Our study demonstrates statistically significant 1.3-fold increased risks of CKD and ESRD in patients using PPIs, but not in patients using H2RAs.

     

Health Utilities in Patients with HIV/AIDS in Thailand

Objectives:  We measured health utility (HU) in Thai HIV/AIDS patients using visual analog scale (VAS), EuroQOL (EQ-5D), and standard gamble (SG), determine the relationships between these HU measures and health-related quality of life (HRQOL) measures of HIV and patient characteristics, and assess the feasibility of the HU methods.
Methods:  A sample of 120 HIV/AIDS patients was identified at Bamrasnaradura Infectious Disease Institute, Thailand, during September to December, 2004. Face-to-face interviews included VAS, SG, and EQ-5D, HRQOL assessment using the Thai abbreviated version of the World Health Organization quality of life (WHOQOL-BREF THAI) and HIV-related symptom instruments, questions about ease of understanding HU approaches and sociodemographic items. Data were analyzed with repeated-measures ANOVA, followed by Dunn–Bonferroni t -test, intraclass coefficients (ICC), Spearman's rank correlation, and multiple linear regressions.
Results:  The mean (95% confidence interval) HUs were as follows: VAS, 0.79 (0.76–0.82); EQ-5D, 0.80 (0.77–0.84); and SG, 0.65 (0.60–0.70). A significant difference in HU by method was found ( P  < 0.001). Agreement by ICC was 0.71 for VAS versus EQ-5D, 0.41 for VAS versus SG, and 0.38 for EQ-5D and SG. The regression models showed that WHOQOL-BREF THAI, frequency of HIV symptoms, and patient characteristics could explain approximately 50% of the variation in the VAS and the EQ-5D and 20% in the SG². Among these three HU methods, the SG was the most difficult task.
Conclusion:  VAS, EQ-5D and SG yielded different HUs for this sample. VAS and EQ-5D showed stronger construct validity with other health measures than SG. From a feasibility perspective, the SG was the least satisfactory of the three approaches.     

Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis

BACKGROUNDHepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death.AIMTo demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients. METHODSWe searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay.RESULTSOf 563 citations, a total of 22 studies (n = 4557) were included in this meta-analysis. The pooled estimated prevalence of HEV infection in SOT patients was 20.2% [95% confidence interval (CI): 14.9-26.8]. The pooled estimated prevalence of HEV infection for each organ transplant was as follows: liver (27.2%; 95%CI: 20.0-35.8), kidney (12.8%; 95%CI: 9.3-17.3), heart (12.8%; 95%CI: 9.3-17.3), and lung (5.6%; 95%CI: 1.6-17.9). Comparison across organ transplants demonstrated statistical significance (Q = 16.721, P = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. The pooled estimated prevalence of de novo HEV infection was 5.1% (95%CI: 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95%CI: 1.9-9.4).CONCLUSIONHEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.