Lungs from hepatitis C donors successfully transplanted in 10 patients

Naveed Saleh, MD, MS, for MDLinx | July 17, 2018

Ten patients in need have successfully received lung transplants from donors with hepatitis C, according to initial results of a study presented at the Global Hepatitis Summit 2018 held in Toronto, Canada, June 14-17. The applied findings from this study are expected to boost the number of lungs available for transplant in North America from 2,600 to 3,600 per year.

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An additional 1,000 lungs could be available for transplant every year in North America by using hepatitis C-positive organs, said surgeon Marcelo Cypel, MD, MSc. (Photo: UHN)

More than 1,400 US patients are currently on the waiting list for a lung transplant. An estimated 20% of patients die while waiting for lungs to become available.

“With the opioids crisis and persistent high rates of intravenous drug use, we have a great number of potential lung donors who are hepatitis C positive—many of whom didn’t even know they were sick when they were alive,” said principal investigator Marcelo Cypel, MD, MSc, Toronto General Hospital Research Institute, Toronto. “The current protocol is to not use these organs, but we started to question if that still made sense in an era when direct antiviral agents (DAAs) can cure hepatitis C.”

The team completed transplants in 10 patients (mean age of donors: 33 years; mean age of recipients: 64 years) between October 2017 and May 2018. The team used the Toronto Ex Vivo Lung Perfusion System (EVLP)—developed at Toronto General in 2008—to determine the safety of the transplants. The EVLP technology keeps the organs perfused while specialists analyze lung function and predict clinical outcomes.

The Toronto Ex Vivo Lung Perfusion System perfuses organs outside of the body, allowing doctors to assess the organ and predict how well it will do before transplantation. (Photo: UHN)

After 6 hours, EVLP decreased hepatitis C counts to very low levels. Although organ recipients were still infected with hepatitis C, they cleared the infection after an average of only 3 weeks of treatment with DAAs.

All patients have since recovered from their transplant surgery. Eight have already tested negative for the virus.

“This is an initial study, but it shows positive results,” said lead investigator Jordan Feld, MD, MPH. “It suggests that it is safe to use these organs which otherwise we could not have used. This could eventually be a big boost for organ donation.”

Researchers expect this study will be followed by a second phase to further assess techniques to use hepatitis C-positive organs.

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