Several health experts including surgeons, transplant physicians and infectious disease health specialists at Brigham and Women’s Hospital were successful in blocking the transmission of hepatitis C virus from infected organ donors to recipients who were in need of hearts or lungs.
The DONATE HCV Trial Team says that hepatitis C-infected thoracic organs can now also be securely transplanted, showing no signs and symptoms of the infection and great results for the transplanted organs in all patients. The patients were given a short course of antivirals to inhibit the growth of viruses.
The research paper is published in the New England Journal of Medicine. The study describes that patients were given antivirals for consecutive 4 weeks within the few hours of the transplantation. It helped in counteracting hepatitis C infection (HCV) contamination in all patients, and, in this manner, growing the pool of healthy heart and lung donor organs.
“There was a 100 percent success rate in terms of HCV treatment and six-month graft survival,” said study author Ann Woolley, MD, MPH, of the Department of Infectious Diseases at the Brigham.
“Direct-acting antivirals have revolutionized the field of hepatitis C treatment and have also created an opportunity to transplant organs from hepatitis C positive donors. While transplants from hepatitis C positive donors have previously been done, the best approach to doing this—when to initiate treatment and how long to treat patients after transplant—, as well as the outcomes for heart and lung transplant recipients, have not previously been systematically studied.”
“This is the largest clinical trial to date for HCV thoracic organ transplantation and provides clear evidence that this shortened regimen, initiated within hours of transplant, can prevent the establishment of hepatitis C in the recipients and lead to excellent outcomes for patients.”
The research paper talks about those 35 patients who enrolled themselves in the study by February 2018. Each and every patient of the 35 patients met the requirements of the trial. All of them had undetectable hepatitis C viral loads and working transplanted organs a half year or more after transplant surgery. Given the examination’s fruitful results, enlistment proceeds and the group has now selected aggregate of 69 members up till now
The group found that almost the majority of the patients who got organs from HCV viral positive donors had proof of HCV infection promptly post-transplantation.
Although all of the patients were taking high-dose immunosuppressive drugs as a feature of the transplant procedure, the ones who took early treatment prevented HCV from further building up. All recipients cleared the infection by fourteen days and hepatitis C virus remained undetectable from that point.
“It was critically important to us to determine that this treatment not only prevented transmission of hepatitis C but also didn’t worsen outcomes for our transplant patients,” said co-author Steve Singh, MD, former surgical director of the Heart Transplantation and Mechanical Circulatory Support in the Department of Cardiac Surgery.
“Our short-term findings to date suggest that graft survival is just as excellent in patients who were transplanted with thoracic organs from hepatitis C positive donors as it was in those who received thoracic organs from non-hepatitis C positive donors during the same period.”
Despite the fact that the number of organ transplantations has increased tremendously in these 5 years, still around 1000 patients die every year waiting for the transplantation of essential organs.
A rise in deaths due to drug intoxication has increased the accessible organs for transplantation, yet donor hepatitis C viral disease has been the main reason due to which the available organs are ineligible for transplantation.
In most of the cases, direct-acting anti-virals, for example, sofosbuvir/velpatasvir, are used to treat the patients infected with hepatitis C. Standard treatment for individuals who are constantly infected with hepatitis C is commonly 8-to-12 weeks, contingent upon the treatment routine applied.
Several different examinations have found that it is possible to treat kidney and liver transplant patients with these medications right on time after transplantation, and such medicines are starting to be utilized to treat heart and lung transplant recipients.
Woolley and his colleagues set out to treat a large group of patients. Their main goal was to treat patients with a short course treatment and collect information on results over a more extended timeframe. The study authors noticed the significance of a shorter length of antiviral treatment prompting fruitful results for patients.
“HCV infection has been a long-standing reason to decline donation of suitable organs,” said co-author Lindsey Baden, MD, director of Clinical Research in the Division of Infectious Diseases at the Brigham.
“What the data show is that transmission does occur, but a short, four-week course of antiviral therapy led to rapid HCV clearance. These data demonstrate how preemptive therapy can stop transmission thus decreasing medication burden, drug interactions, and cost.”
The group likewise examined safety outcomes to make sure that there would be no hepatitis adverse event. The analysts reported a numerical increment in intense cell rejection among lung transplant patients, however, this pattern was not measurably noteworthy.
“This study provided a unique opportunity to explore the utilization of thoracic organs from hepatitis C positive donors for transplantation, which to date have been underutilized despite being relatively common in the current donor population,” said co-author Hilary Goldberg, MD, MPH, the medical director of the Lung Transplant Program and the former lead for the Solid Organ Transplant Quality Assurance and Process Improvement Program at the Brigham.
“I am very encouraged by the results so far, and the potential that this study may allow us to provide transplantation successfully to the many recipients who might otherwise never have access to it.”