A recent trial has shown that heart and lungs from donors infected with hepatitis C can be safely transplanted, without recipients becoming infected with the virus.
A four-week course of direct-acting antiviral agents prevented the establishment of infection in all recipients and those who have been followed for six months are still infection-free.
The study, which has been published in the New England Journal of Medicine, is the largest of its kind to assess the safety of transplanting the organs from donors infected with the hepatitis C virus (HCV).
Solving organ shortages
Lead author Ann Woolley, (Brigham and Women’s Hospital, Massachusetts, US) estimates that the ability to safely transplant hearts and lungs from HCV-infected donors could increase supply of the organs by at least one-quarter.
In the US, more than 5,000 patients are currently awaiting a lung or heart transplant, but the shortage of donor organ availability means around one thousand patients die each year while they wait for the replacement organs.
In the wake of the current opioid crisis, an increasing number of donated organs now come from IV drug users. However, the donation of HCV-infected organs has historically been associated with high transmission rates to recipients and they are not typically used for transplant.
Usually, organs are discarded if donors are even suspected of having HCV infection, which is the most common type of chronic blood infection in the US.
Antivirals have led to high cure rates for hepatitis C
However, the advent of a new antiviral regimen in 2014 that has proved well-tolerated and to have high cure rates for chronic HCV has laid the foundations for a new trial that started enrolling patients in March 2017. The usual criteria were used to screen potential donors, with the exception that they were not disqualified for having a current or past HCV infection.
Forty-four patients received HCV-positive hearts or lungs, 35 of whom were followed up for at least six months. Antiviral treatment was initiated within a few hours of surgery and the treatment regimen was continued for four weeks.
Immediately after transplantation, all recipients had hepatitis C viral loads proportional to those of the donors. The majority cleared the virus within a few days and all patients had undetectable viral loads by around the two-week mark, reports Woolley.
Hepatitis C was ‘undetectable’ in transplant recipients
Of the 35 patients who completed 6 months of follow-up, all had excellent graft function and an undetectable viral load, with no treatment-related serious adverse events reported.
In an associated editorial, professor of Medicine at the University of Pennsylvania, Emily Blumberg, says that at least in the short-term, transplants from HCV-positive donors offer a very promising way to get people transplanted faster and expand the donor pool.
The authors conclude:
The advent of direct-acting antiviral agents to treat hepatitis C virus (HCV) infection has raised the possibility of substantially increasing the donor organ pool by enabling the transplantation of hearts and lungs from HCV-infected donors into recipients who do not have HCV infection.”