Twenty patients who volunteered to get transplants of kidneys infected with hepatitis C have now survived the operation and been cured of the virus.
Nearly 100,000 Americans are waiting for kidneys, and many precious donated organs are thrown away because they have the curable infection.
After transplants, the patients’ new organs are working fine thanks to medication that got rid of the virus, the University of Pennsylvania researchers reported Monday.
It was a small study involving just 20 patients, but researchers say it suggests that organs currently going to waste just might help speed transplants for patients who wait years to get one.
Kiran Shelat, a 65-year-old retired civil engineer, poses for a portrait in his home in Pennsylvania after receiving an experimental, hepatitis C-infected kidney transplant
‘When there’s such a bad organ shortage, we can’t just do business as usual,’ said Dr Peter Reese, a University of Pennsylvania kidney specialist who led the study. ‘We need to shake off that these organs aren’t valuable and that people will not want them.’
In the US, almost 95,000 people are on the national kidney waiting list but only 19,850 received a transplant in 2017, according to the United Network for Organ Sharing. That only covers about 20 percent of all cases.
Hepatitis C is an infection that can quietly destroy someone’s liver if untreated.
Transplanting other organs from patients with the virus can infect the recipients.
However, past research has estimated that transplant patients who received hepatitis C-positive kidneys had only a one percent lower survival rate after the first year than patients that got uninfected kidneys.
Over three years, there was a two percent difference in their survival rates.
Still this risk has dissuaded doctors, patients and organ harvesters from keeping and using organs from donors who test positive for hepatitis C.
Precautions against the virus, however, may have cost thousands of patients life-saving organs over the years.
Between 1995 and 2009, Johns Hopkins University tracked the fates of 93,000 donated kidneys. Of those, some 3,500 were hepatitis C positive and thrown away.
Even patients who were positive for hepatitis C before transplant – 4,800 of them over the 14-year period – were given donor kidneys that were negative for the virus.
So kidneys that could have gone to people who already had the virus were thrown out, those people got uninfected kidneys, and many patients got no kidneys at all out of fear of a curable infection.
But with powerful new drugs now available that promise to cure them, Reese’s team decided to test if it’s safe to transplant infected kidneys to people who don’t already have the virus, too -but who might not survive the wait for a healthy organ.
Twelve weeks of hepatitis treatment cleared the virus in all 20 patients tested so far.
Since receiving his kidney transplant, Shelat has even been able to resume exercising
Compared to patients who received uninfected organs, their new kidneys work just as well, even a year after the procedure. Merck & Co., helped fund the research and provided the pills in the study. Results were published in the journal Annals of Internal Medicine.
Kiran Shelat, a 65-year-old civil engineer from Yardley, Pennsylvania, had spent two years on the transplant waiting list before signing up for the experiment.
He now feels energetic, and can work out in the gym and attend family events. So far, there’s no sign of the virus in his bloodstream.
‘This is a lifesaver,’ Shelat said. ‘Get off the list; get the kidney. There is nothing to be afraid of.’
Transplant specialists are keeping a watchful eye.
‘As long as the patient accepts the risk, I support this,’ said Dr Josh Levitsky, a professor of organ transplantation at Northwestern University who is not part of the team.
Getting an infected kidney may outweigh the burden of dialysis, which many patients find physically exhausting, said Dr Matthew Cooper, a transplant surgeon at Georgetown University Hospital.
‘People have to plan their entire lives around dialysis,’ said Cooper, who was not part of the research. ‘It is a rotten lifestyle.’
It costs about $88,000 a year to undergo dialysis, according to the United States Renal Data System. Merck has set a price of $54,600 for a round of its hepatitis C medication, Zepatier.
Most insurance companies still don’t cover the drug for transplant patients, Reese said.
The American Society of Transplantation has said larger studies are needed before transplanting infected kidneys is done routinely.
In 2016, Johns Hopkins University launched a similar experiment with 10 people. All of them are now cured. Researchers in the United Kingdom are already discussing the possibility to use organs with hepatitis C in patients who don’t have the virus.
The University of Pennsylvania team are in the midst of a similar experiment using transplanted hearts from donors with hepatitis C.
‘While larger, longer term studies are important to confirm these results, we can confidently say that hospitals nation-wide could perform hundreds or thousands more transplants if we increased our acceptance of organs from donors with hepatitis C,’ said Dr Reese.
Doctors have found not signs of hepatitis C in Shelat’s bloodstream
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