HBsAg-positive kidneys confer similar allograft and patient survival in kidney transplant recipientsHepatitis B status of donor kidneys does not affect survival

PURPOSE: This systematic review and meta-analysis examines the evidence related to the use of HBV positive kidneys into non-viremic kidney transplant recipients (KTRs). METHODS: We searched PubMed and Embase through November 2025 and identified studies of recipients of hepatitis B surface antigen positive (HBsAg+) or viremic kidneys. Studies with a comparison group of KTRs of HBV negative kidneys that reported on patient and allograft survivals were included in the meta-analysis. The risk ratios (RR) for patient and allograft survivals were pooled to obtain the estimate and 95% confidence interval, at 1-, 3-, and 5-years post-transplant. Viral transmission including HBsAg development, HBV viremia, or hepatitis was also reviewed. RESULTS: Eleven studies were included in the systematic review and 6 in the meta-analysis. They included 638 KTRs of HBV positive kidneys and 2800 recipients of HBsAg negative non viremic kidneys. At 1, 3, and 5 years, the RR of allograft survival was not statistically different between the 2 groups and was 1 [0.98-1.01], 1.01 [0.98-1.04], and 1.00 [0.91-1.09] respectively. Similarly, the RR of patient survival was comparable between the 2 groups. The rate of HBV transmission was low (4.94%), especially when prophylaxis was used and when recipients were immune pre transplant. CONCLUSION: Kidneys from HBV infected donors confer similar patient and allograft survival than those from HBV negative donors. They may be used to expand the donor pool, in immune KTRs and with appropriate prophylaxis, in light of this emerging evidence of safety with very low reported rates of transmission.