title: Network meta-analysis on prophylactic regimens against recurrent hepatitis B virus infection after liver transplantation.
abstract: BACKGROUND
  Previous meta-analyses of non-randomized studies suggested that the hepatitis B immunoglobulin (HBIG) and lamivudine (LAM) combination therapy was significantly better than HBIG or LAM alone in preventing hepatitis B virus (HBV) recurrence after transplantation. However, substantial evidences supporting the superiority of combination therapy are still insufficient. Therefore, we sought to conduct a multiple-treatment comparison to integrate current data which was based on randomized controlled trials (RCTs).
  
  
  METHODS
  We searched electronic databases of PubMed, Embase and the Cochrane Library for eligible literatures. Pair-wise meta-analyses were to synthesize studies comparing the same pair of treatments. Appropriate networks for overall and 1-year recurrence rates were established. Bayesian algorithm was used in multiple-treatment comparisons to compare relative effects of all included regimens.
  
  
  RESULTS
  Four RCTs on prophylaxis against HBV recurrence after liver transplantation, involving 162 participants, were included. HBIG mono-therapy, LAM mono-therapy and HBIG plus LAM showed no statistically difference in risk ratios (RRs) in terms of overall HBV recurrence rate in network meta-analysis. Nevertheless, HBIG mono-therapy had potential advantage compared with combination of HBIG and LAM in 1-year HBV recurrence rate [RR 0.00, 95% confidence interval (CI): 0.00 to 0.91] while the rest comparisons revealed no significance. The cumulative probabilities of treatments associated with the highest recurrence were (overall HBV recurrence rate, 1-year HBV recurrence rate): HBIG (18%, 1%), LAM (32%, 42%) and HBIG plus LAM (50%, 57%).
  
  
  CONCLUSIONS
  This network meta-analysis based on data from RCTs showed no significant differences among HBIG mono-therapy, LAM mono-therapy, combination of HBIG and LAM in overall HBV recurrence rate after liver transplantation. Further well designed and large-scale RCTs are warranted to clarify these issues.
authors.affiliation: Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China;
authors.forename: Yaxiong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China;
authors.forename: Shiyang
authors.initials: S
authors.lastname: Kang
authors.affiliation: Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Fang
authors.affiliation: Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liang
keywords: Hepatitis B; hepatitis B immunoglobulin (HBIG); lamivudine (LAM); liver transplantation; network meta-analysis