title: Is hepatitis B immunoglobulin necessary in prophylaxis of hepatitis B recurrence after liver transplantation? A meta-analysis.
abstract: OBJECTIVE
  Application of nucleoside analogues and hepatitis B immunoglobulin (HBIG) has reduced hepatitis B virus (HBV) recurrence rate after liver transplantation (LT) dramatically. Recent data suggests therapy without HBIG is also effective. We sought to evaluate the necessity of HBIG in prophylaxis of HBV recurrence after LT.
  
  
  METHODS
  A meta-analysis was performed. PubMed/MEDLINE, Web of Knowledge and other databases were searched for eligible literatures. The major end points were recurrence rate, patient survival, and YMDD mutant. Risk difference (RD) or risk ratio (RR) was calculated to synthesize the results.
  
  
  RESULTS
  Nineteen studies with a total of 1484 patients were included in this analysis. Application of HBIG was helpful to reduce HBV recurrence [P<0.001; RD = 0.16; 95% confidence interval (CI)(0.12, 0.20)] and virus mutants [P<0.001; RR = 3.13; 95%CI (1.86-5.26)], it also improved patients' 1-year [P = 0.03; RD = 0.08; 95%CI (0.01, 0.15)] and 3-year survival rates [P = 0.005; RD = 0.17; 95%CI(0.05, 0.28)]. No significant difference was found for patients' 5-year survival [P = 0.46; RD = -0.06; 95%CI (-0.21, 0.10)]. Sub-group analysis showed that in patients with positive pre-operative HBV DNA status, HBIG was necessary to reduce HBV recurrence rate (P<0.001; RD = 0.42; 95%CI (0.32, 0.52)). In patients with negative HBV DNA, combined therapy gained no significant advantages (P = 0.18; RD = 0.06; 95%CI (-0.03, 0.14)). Non-Lamivudine (non-LAM) antiviral drugs performed as well as combination therapy in prophylaxis of HBV recurrence after LT (P = 0.37; RD = 0.06; 95%CI (-0.02, 0.14)).
  
  
  CONCLUSIONS
  HBIG with nucleoside analogues is helpful to reduce HBV recurrence and virus mutants. The necessity of HBIG in prophylaxis of HBV recurrence after LT when using new potent nucleoside analogues, especially for patients with negative pre-transplant HBV DNA status remains to be evaluated.
authors.affiliation: Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China.
authors.forename: Peijie
authors.initials: P
authors.lastname: Wang
authors.affiliation: Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Hepatobiliary Surgery Department, the University of Hong Kong - Shenzhen Hospital, Shenzhen, Guangdong, China.
authors.forename: Ngalei
authors.initials: N
authors.lastname: Tam
authors.affiliation: Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Haochen
authors.initials: H
authors.lastname: Wang
authors.affiliation: Liver Disease Department, Shijiazhuang Fifth Hospital, Shijiazhuang, Hebei, China; Clinical Center for Liver Disease, University of Texas, Southwestern Medical Center, Dallas, Texas, United States of America.
authors.forename: Huanwei
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Nephrology Department, University of Texas, Southwestern Medical Center, Dallas, Texas, United States of America.
authors.forename: Philip
authors.initials: P
authors.lastname: Chen
authors.affiliation: Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Linwei
authors.initials: L
authors.lastname: Wu
authors.affiliation: Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiaoshun
authors.initials: X
authors.lastname: He
mesh_terms: D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D006509:Hepatitis B / Q000097:blood / Q000235:genetics / Q000517:prevention & control*; D006515:Hepatitis B virus; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D016031:Liver Transplantation; D009154:Mutation; D012008:Recurrence
chemical_list: D004279:DNA, Viral; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin
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