The strategy and efficacy of prophylaxis against hepatitis B virus recurrence after liver transplantation for HBV-related diseases in the era of potent nucleos(t)ide analogues: A meta-analysis
| Autor: | Zhou Hua Hou, Guo Zhu Yao, Ming Shu Li, De Ming Tan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Hepatitis B virus Carcinoma Hepatocellular medicine.medical_treatment Viremia Liver transplantation medicine.disease_cause Gastroenterology Antiviral Agents 03 medical and health sciences 0302 clinical medicine Recurrence Internal medicine Secondary Prevention Medicine Humans business.industry Liver Neoplasms medicine.disease Hepatitis B digestive system diseases Confidence interval Liver Transplantation Treatment Outcome 030220 oncology & carcinogenesis Superinfection Meta-analysis Hepatocellular carcinoma 030211 gastroenterology & hepatology Hepatitis D virus Neoplasm Recurrence Local business |
| Zdroj: | Journal of digestive diseasesREFERENCES. 22(2) |
| ISSN: | 1751-2980 |
| Popis: | Objectives This meta-analysis aimed to evaluate the clinical outcome of liver transplant (LT) recipients under potent nucleoside or nucleotide analogue (NA)-based regimens and investigate different prophylactic schemes. Methods We followed PRISMA statement to conduct this study. Two reviewers independently searched relevant literature via PubMed, Embase, Ovid MEDLINE, Web of Science and Insightmeme. Studies were included if they evaluated hepatitis B virus (HBV) recurrence under potent NA-based regimens in patients who received HBV-related LT. Primary and secondary outcomes were HBV recurrence, hepatocellular carcinoma (HCC) recurrence, all-cause and HBV recurrence-related mortality. Incidences with 95% confidence intervals were calculated and assessed by fixed and random effects models. Subgroup analyses were used to examine the impact of different treatment strategies. Results Altogether 25 studies (N = 2327) were included, with a pooled HBV recurrence rate of 1.01% (95% CI 0.53%-1.59%). HBV viremia or hepatitis D virus superinfection did not influence HBV recurrence significantly (P = 0.23 and 0.71, respectively). The recurrence rate under an indefinite combination of potent NA and hepatitis B immunoglobulin (HBIG) was lower than that under potent NA monotherapy (P = 0.000) and similar to that under NA plus a finite course of HBIG (P = 0.48). The pooled HCC recurrence rate was 5.34% (95% CI 0.78%-12.48%). HBV recurrence-related mortality and all-cause mortality were 0% and 6.95% (95% CI 4.30%-10.08%), respectively. Conclusions Potent NA-based regimens provide satisfactory HBV antiviral prophylaxis and improve long-term outcomes for LT recipients. A finite combination of potent NA and HBIG is an alternative to life-long dual therapy. |
| Databáze: | OpenAIRE |
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