Evidence-backed practice increases the number of available organs

hepatitis C-positive kidneys_DaloulA decade ago, transplanting a hepatitis C-positive kidney into a hepatitis C-negative recipient would have been unthinkable. 

Reem Daloul, MD, transplant nephrologist in The Ohio State University Wexner Medical Center Division of Nephrology, says curative treatments for hepatitis C have made use of hepatitis C-infected organs a viable option for non-infected recipients. 

At the Ohio State Wexner Medical Center, Dr. Daloul adds, this practice has become standard of care. The team has now safely and successfully transplanted more than 60 hepatitis C-positive kidneys into patients in need of a transplant. 

What started in 2019 through a 30-patient clinical trial has been expanded to include those in need of multi-organ transplants, including kidney/pancreas and kidney/liver. 

“We expected good outcomes from our study, but we had excellent outcomes,” says Dr. Daloul, who served as principal investigator for the Use Hep-C, Utilization of Hepatitis C Positive Kidneys in Negative Recipients study. “The patients we’ve liberated from dialysis through this advanced approach to transplant care are very appreciative for the opportunity.” 

Overcoming barriers to early adoption

While the use of hepatitis C-positive kidneys is becoming routine at the Ohio State Wexner Medical Center, the practice has yet to become standard at most transplant centers across the country. 

Hepatitis C-positive kidney study infoA recent national survey of transplant clinicians found that only 14% of responding centers use hepatitis C-positive (actively infected) donor organs as standard-of-care treatment.

Dr. Daloul says insurance coverage could be one barrier to making this approach the standard-of-care nationwide.

“Early on in our study, we had to deal with a lot of pushback from payers who refused to cover the therapy needed to make this type of transplant successful,” Dr. Daloul says. “As we began doing more and more of these procedures, we were able to educate insurers about the safety of this treatment option, which has made it much easier for us to get the drug therapy covered.”

Filling a national need

Dr. Daloul says adding hepatitis C-positive organs to the donor pool is one critical step toward reducing transplant wait time and saving more lives.

October 2020 data from the U.S. Department of Health & Human Services Organ Procurement and Transplantation Network (OPTN) showed nearly 92,000 people on the waiting list for a kidney transplant. So far in 2020, there have been less than 20,000 kidney donors — both living and deceased.

“This represents a big gap between those in need and what’s available,” Dr. Daloul says. “Every single extra donor we can add to the pool is another eight lives saved.”

Identifying viable donors

In many cases, hepatitis C-positive organs come from donors who die from drug intoxication.

“Despite significant efforts to combat the opioid crisis, deaths related to drug intoxication continue to rise,” Dr. Daloul says. “Many of these potential donors might also have hepatitis C, but with the proper care and follow-up, these organs can be viable transplant options. 

“Centers like ours have infrastructure and clinical expertise in place to ensure safe and successful treatment and long-term management for those transplanted with hepatitis C-positive organs.”

Next steps

Dr. Daloul and team are now completing study follow-up and plan to present their work at the 2021 meeting of the American Transplant Congress.

They are also eyeing the next phase of their research work, which includes evaluation of any association between hepatitis C and other post-transplant viral complications. They will also review data for post-transplant development of donor-specific antibodies.

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