{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:21:26Z","timestamp":1792002086154,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004196","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000}}],"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"1.3.5 Project for Disciplines of Excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University","award":["2021HXFH007"],"award-info":[{"award-number":["2021HXFH007"]}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Current guidelines do not recommend routine antiviral prophylaxis to prevent hepatitis B virus (HBV) reactivation in non-liver solid organ transplant (SOT) recipients with resolved HBV infection, even in anti-hepatitis B surface antigen (anti-HBs)-negative recipients and those receiving intense immunosuppression. This systematic review and meta-analysis aimed to determine the incidence, risk factors, and clinical outcomes of HBV reactivation in non-liver SOT recipients.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods and findings<\/jats:title><jats:p>Three databases (PubMed, Embase, and Cochrane Library) were systematically searched up to December 31, 2022. Clinical studies reporting HBV reactivation in non-liver SOT recipients were included. Case reports, case series, and cohort studies with a sample size of less than 10 patients were excluded. Random-effects analysis was used for all meta-analyses. We included 2,913 non-liver SOT recipients with resolved HBV infection from 16 retrospective cohort studies in the analysis. The overall HBV reactivation rate was 2.5% (76\/2,913; 95% confidence interval [95% CI 1.6%, 3.6%]; I<jats:sup>2<\/jats:sup>= 55.0%). Higher rates of reactivation were observed in recipients with negative anti-HBs (34\/421; 7.8%; 95% CI [5.2%, 10.9%]; I<jats:sup>2<\/jats:sup>= 36.0%) by pooling 6 studies, experiencing acute rejection (13\/266; 5.8%; 95% CI [2.3%, 14.5%]; I<jats:sup>2<\/jats:sup>= 63.2%) by pooling 3 studies, receiving ABO blood type-incompatible transplantation (8\/111; 7.0%; 95% CI [2.9%, 12.7%]; I<jats:sup>2<\/jats:sup>= 0%) by pooling 3 studies, receiving rituximab (10\/133; 7.3%; 95% CI [3.4%, 12.6%]; I<jats:sup>2<\/jats:sup>= 0%) by pooling 3 studies, and receiving anti-thymocyte immunoglobulin (ATG, 25\/504; 4.9%; 95% CI [2.5%, 8.1%]; I<jats:sup>2<\/jats:sup>= 49.0%) by pooling 4 studies. Among recipients with post-transplant HBV reactivation, 11.0% (7\/52; 95% CI [4.0%, 20.8%]; I<jats:sup>2<\/jats:sup>= 0.3%) developed HBV-related hepatic failure, and 11.0% (7\/52; 95% CI [4.0%, 20.8%]; I<jats:sup>2<\/jats:sup>= 0.3%) had HBV-related death. Negative anti-HBs (crude odds ratio [OR] 5.05; 95% CI [2.83, 9.00];<jats:italic>p<\/jats:italic>&lt; 0.001; I<jats:sup>2<\/jats:sup>= 0%), ABO blood type-incompatible transplantation (crude OR 2.62; 95% CI [1.05, 6.04];<jats:italic>p<\/jats:italic>= 0.040; I<jats:sup>2<\/jats:sup>= 0%), history of acute rejection (crude OR 2.37; 95% CI [1.13, 4.97];<jats:italic>p<\/jats:italic>= 0.022; I<jats:sup>2<\/jats:sup>= 0%), ATG use (crude OR 3.19; 95% CI [1.48, 6.87];<jats:italic>p<\/jats:italic>= 0.003; I<jats:sup>2<\/jats:sup>= 0%), and rituximab use (crude OR 3.16; 95% CI [1.24, 8.06];<jats:italic>p<\/jats:italic>= 0.016; I<jats:sup>2<\/jats:sup>= 0%) increased the risk of reactivation. Adjusted analyses reported similar results. Limitations include moderate heterogeneity in the meta-analyses and that most studies were conducted in kidney transplant recipients.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>Non-liver SOT recipients with resolved HBV infection have a high risk of HBV-related hepatic failure and HBV-related death if HBV reactivation occurs. Potential risk factors for HBV reactivation include rituximab use, anti-thymocyte immunoglobulin use, anti-HBs negative status, acute rejection history, and ABO blood type-incompatible transplantation. Further research on monitoring and routine antiviral prophylaxis of non-liver SOT recipients at higher risk of HBV reactivation is required.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pmed.1004196","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T17:52:14Z","timestamp":1678902734000},"page":"e1004196","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Incidence, risk factors, and clinical outcomes of HBV reactivation in non-liver solid organ transplant recipients with resolved HBV infection: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9710-7872","authenticated-orcid":true,"given":"Saifu","family":"Yin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiapei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2166-2217","authenticated-orcid":true,"given":"Tao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianding","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"pmed.1004196.ref001","unstructured":"World Health Organization. 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