Improved antivirals could help expand the number of organs available for donation
People who received kidneys from donors infected with hepatitis C did not become ill with the virus, thanks to treatment with newer drugs that can cure the disease, a small study reports.
Ten patients not previously infected with hepatitis C took doses of powerful antiviral medications before and after receiving the transplants. None of the patients developed chronic infections, researchers report online March 6 in the Annals of Internal Medicine. The finding could help make more kidneys available for transplants.
“If this increases access to transplantation, then this is a great benefit,” says Jay Fishman, a transplant infectious disease specialist at Massachusetts General Hospital in Boston.
As of January 2016, more than 100,000 people in the United States were awaiting transplants, according to the National Kidney Foundation. In many areas, patients can linger on waiting lists for more than five years. In 2014, there were about 17,000 kidney transplants in the country, and nearly 4,800 people died while waiting.
Traditionally, organs from donors with hepatitis C were offered to recipients already infected with the disease, because the virus could be transmitted during a transplant. And one of the main drugs previously used to treat the infectious liver disease was not very effective and had many side effects, including the possibility of transplant rejection. But in the last several years, more effective drugs, called direct-acting antivirals, have been approved for use. These drugs cure hepatitis C in more than 95 percent of patients.
At the same time, more hepatitis C-positive organs have become available. The increase is likely due to rising numbers of overdose deaths from opioids (SN: 6/10/17, p. 22), says Christine Durand, a transplant infectious disease specialist at Johns Hopkins School of Medicine.
But many hepatitis C-positive organs are not used. A 2015 study in the New England Journal of Medicine reported that 4,144 kidneys from infected donors were discarded from 2005 to 2014. There are “very high-quality organs from hepatitis C infected people that could be used to save lives,” Durand says.
She and colleagues treated 10 patients who received hepatitis C-positive kidneys with the new drug regimens. Twelve weeks after drug treatment had ended, the researchers did not detect hepatitis C virus in the patients’ blood. But another test indicated the presence of antibodies to the virus in five of the patients. Durand says this may be a sign that the drugs didn’t prevent early infection in those cases, but still cured it. The bottom line is that none of the patients developed chronic infections, she says.
The study demonstrates that “we can use these organs from patients with hepatitis C safely,” and that even if the virus is transmitted, “we can manage it,” Fishman says. Massachusetts General Hospital has, under strict protocols in emergency cases, transplanted hearts, lungs and livers from donors with hepatitis C to uninfected patients, who were given the antiviral medications, he says. Those patients were treated successfully as well.
Whether someone will accept an organ from an infected donor will depend on a patient’s risk tolerance, Durand says. At Johns Hopkins Comprehensive Transplant Center, the wait for an organ from a deceased donor can be years, but “with this strategy you can get an offer within weeks,” she says. “I hope the findings of this study will encourage future patients.”
C. Durand et al. Direct-acting antiviral prophylaxis in kidney transplantation from Hepatitis C virus-infected donors to noninfected recipients: an open-label nonrandomized trial. Annals of Internal Medicine. Published online March 6, 2018. doi:10.7326/M17-2871.
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