Every day, on average, 22 people die in the United States alone while waiting to receive an organ transplant. Typically, organs from patients with diseases that can be spread to recipients are simply discarded. But a new approach from researchers at the University of Pennsylvania could change that, increasing the organ pool available to surgeons.
The work the researchers did focused on kidneys from donors infected with the Hepatitis C virus (HCV).
Patients who had been waiting for kidney transplants for at least 18 months were approached by the researchers and told that they could have kidneys from patients infected with HCV. The plan was to save lives with the transplant and cure the hepatitis afterwards.
After being thoroughly educated on the procedure and the risks, ten patients were selected to receive kidneys that were deemed to be high quality after genetic profiling of the deceased donors, who all had HCV. On average, patients received the new kidneys 58 days after enrolling in the trial and all ten of them tested positive for HCV after the surgery.
Fortunately, in early 2016, pharmaceutical maker Merk received approval for their anti-Hepatitis-C drug, Zepatier. All of the patients who had received the kidneys were treated with a 12-week course of the drug and all ten of them were cured of the infection.
"For so long, HCV was a virus with a very negative stigma associated with it, especially among physicians. So it was interesting to see that patients were quick to jump at the chance to get this transplant, despite the possibility that they could get hepatitis C permanently," said study co-leader Peter Reese, an assistant professor of Medicine and Epidemiology at Penn and chair of the Ethics Committee for the United Network of Organ Sharing (UNOS). "Going into the study, we knew it was a possibility that some or all of the patients would contract HCV, and that they could have the disease for the rest of their lives if we were unsuccessful. But for these patients, getting off of dialysis and getting back to their normal lives was very much worth the risk."
The researchers are hopeful that the technique can now move beyond just kidneys to using heart donations from HVC-positive donors and eventually to livers and lungs as well. The team has received an extension on their study in which they will test the kidney procedure on 10 more patients.
"We started this trial in the hopes that, if successful, we could open up an entirely new pool of donor organs, and effectively transplant hundreds, if not thousands, more patients who are awaiting a lifesaving organ," said David S. Goldberg, an assistant professor of Medicine and Epidemiology in the Perelman School of Medicine at the University of Pennsylvania. "Historically, Hepatitis C-infected kidneys were often discarded, and were thought to be damaged or too 'high-risk.' Our pilot data demonstrate the ability to cure the contracted virus following transplantation in this patient population. If future studies are successful, this may be a viable option for patients who may otherwise never see a transplant."
The research was presented yesterday at the 2017 American Transplant Congress in Chicago, while simultaneously receiving publication in the New England Journal of Medicine.
Source: Penn Medicine
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