More heart, lung transplants possible with therapy to clear Hep C from donor organs

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(Reuters Health) – The presence of hepatitis C in potential organ donors has long prevented hearts and lungs from going to patients who desperately need them, but that prohibition may soon disappear thanks to a technique that attacks the virus before it can gain a foothold in the recipient.

Doctors at Brigham and Women’s Hospital in Boston say they have eliminated the risks that came with all 69 hepatitis C-tainted hearts or lungs they transplanted into patients since March 2017. They achieved it with four weeks of antiviral therapy given to organ recipients that began just hours after the transplant surgery.

Transplant recipients already must receive a lot of drugs to prevent their bodies from rejecting a new organ. Doctors had feared that adding the hepatitis-C treatment might increase the risks, but they found no evidence that it added to the burden of recovery.

The virus tried to move from the infected lungs or heart into the liver, where it thrives, but the antiviral treatment managed to overwhelm the virus in every case, according to the report on results with the first 35 patients published in the New England Journal of Medicine.

“We were surprised that it was a 100 percent success. That was the part that was very encouraging,” lead author Dr. Ann Woolley of the hospital’s division of infectious diseases told Reuters Health in the telephone interview.

Acting quickly meant the virus “didn’t have time to get to the liver and set up shop and replicate,” she said. It also allowed the doctors to use just four weeks of therapy instead of the usual 12 weeks that adults with hepatitis C receive.

The standard cost of the therapy, which used sofosbuvir and velpatasvir, is about $75,000. In these cases it was roughly $25,000.

“We can probably do an even shorter duration of treatment,” Woolley said.

The patients will continue to be followed to see if long-term side effects of the treatment appear.

A similar technique already makes it possible to transplant kidneys and livers from donors who have hepatitis C. A few transplant teams have also tried giving some version of the treatment to their heart and lung recipients. But the new study looked at a large group of patients treated for a short period and followed for several months.

“We needed to see that the survival-at-six-month data were not different” than for patients who do not receive a hepatitis C-tainted organ,” Woolley said. “That’s what the patients care about.”

An estimated 1,000 patients in the United States die each year because they can’t get a heart or lung transplant. Many potential donors, including the growing number of people who die from a drug overdose, are not eligible because they’re infected with hepatitis C, which is typically spread by sharing needles.

One reason doctors had been cautious about trying the anti-hepatitis treatment on heart and lung recipients was that those organs tend to pack more hepatitis C virus particles than an organ like the kidney.

And if a kidney transplant fails, the risk to a patient is lower than if the heart or lungs don’t survive.

The study, which was not financed by any drug company, was known as DONATE HCV.

SOURCE: bit.ly/2GM2xra The New England Journal of Medicine, online April 3, 2019.