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May 24, 2017

Docs have successfully transplanted kidneys infected with hep C. Are hearts next?

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Researchers at Johns Hopkins University and the University of Pennsylvania have been exploring whether kidney transplants performed with hepatitis C-infected organs can be done safely—and initial trial results suggest they can, Karen Weintraub reports for STAT News.

Transplant market updates

Investigating the previously unthinkable

The idea of transplanting a hepatitis C-infected organ into a healthy patient was previously unthinkable. Hepatitis C, if left untreated over a period of years, can destroy a person's liver. But breakthrough hepatitis C drugs with 95 percent cure rates and relatively mild side effects have changed that calculation.

Nearly 100,000 people are on the national kidney waiting list, but only 17,000 people receive a kidney transplant each year, according to the United Network for Organ Sharing. And each year, 4 percent of people on the waiting list die while waiting for a kidney.

A surprising strategy to reduce the organ crunch: Use hepatitis C-positive kidneys

Meanwhile, about 1,000 hepatitis C-infected kidneys are discharged each year. Donors with hepatitis C have an average age of 37—younger than non-infected donors, Weintraub reports. And Weintraub points out that while many such donors contracted the virus through drug use, their organs are "relatively healthy."

Pilot findings

For the trial, the researchers recruited 10 volunteers in need of a kidney transplant who at the study's outset did not have hepatitis C and agreed to receive a kidney from a donor infected with the virus.

Though all of the participants contracted hepatitis C, the researchers said each were cured so quickly that they did not experience any of the disease's effects. To treat the virus, participants took medication for 12 weeks.

While the trial patients reported overall success Goldberg said the experimental therapy was not an easy sell. Some patients were uncomfortable with any sort of experimental therapy, while others were opposed to the prospect of contracting the infection.

What's next

Given the success of the pilot program, the University of Pennsylvania researchers are now looking to test transplanting hearts infected with hepatitis C, Weintraub reports.

According to Richard Formica, director of transplant medicine at the Yale University School of Medicine, there were about 3,200 heart transplants last year, while nearly 4,000 people waited for a donation.

However, challenges remain: The course of a breakthrough treatment for hepatitis C can be as much as $95,000 for a 12-week course, and insurers haven't agreed to cover medication for individuals who contract the infection via a transplant—even though it's cheaper than a year of dialysis, Formica noted.

Peter Reese, a kidney specialist who helped lead the research, called the hepatitis C treatment costs "the big mountain ahead."

Still, Goldberg, Formica, and Reese said the latest findings should lead the way for more trials with hepatitis C-infected organs, which, if successful, would help add infected organs to the donation pool. "The opportunity is large," Goldberg said (Weintraub, STAT News, 5/15).

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