Thursday, May 19, 2022

Transplanting Hepatitis C Positive Kidneys

Effects On Kidney Donors With Hepatitis C

Using Hepatitis C-Infected Kidneys in Transplantation | EXPANDER Study FAQ’s

Evidence suggests that in the general population, people who donate a kidney can live a regular life with their one remaining kidney, although there is a long-term risk of slightly high blood pressure.

When doctors remove one kidney, the remaining kidney compensates by increasing its blood-filtering capacity. People should experience a return of total kidney function to about 70% within 10 or 11 days of donating a kidney. In general, kidney donation may reduce someones life expectancy by 0.51 year.

There is little research on how donating a kidney affects HCV-positive people. Often, HCV-positive kidney donors are deceased individuals who have requested that doctors use their organs in transplant procedures.

If an individual is HCV-positive and wishes to donate a kidney during their lifetime, they should discuss it with their doctor. As chronic HCV can damage the kidneys, it may not be advisable to donate one due to the risk of this complication developing later on.

One Year Posttransplant Recipients Of Hepatitis C Kidneys Disease

In a small study, doctors at Johns Hopkins have successfully transplanted 10 hepatitis C-infected kidneys into patients without hepatitis C…

In a small study, doctors at Johns Hopkins have successfully transplanted 10 hepatitis C-infected kidneys into patients without hepatitis C and prevented the patients from becoming infected by hepatitis C. The success of these transplants could mean more organs being available for the nearly 100,000 people in the U.S. currently waiting for a kidney transplant.

Right now, most of the usable organs from donors with hepatitis C are discarded because there are very few hepatitis C-positive recipients on the waiting list, says Niraj Desai, M.D., an assistant professor of surgery at Johns Hopkins University School of Medicine and senior author of the new paper, published in Annals of Internal Medicine. Figuring out how to use these kidneys is a way to do more transplants and save more lives.

Until recently, treating hepatitis C was difficult treatment regiments often included weekly injections, led to serious side effects that not all patients could tolerate and didnt cure all cases of the viral infection. That meant that organs including kidneys from hepatitis C-positive people were considered too high-risk to transplant into patients without the virus.

This was an overwhelmingly positive study, adds Durand.

Were always trying to expand what we consider acceptable for an organ donor, says Durand.

Transplanting Organs From Hepatitis C

Doctors at UAB are now able to safely transplant organs from hepatitis C-positive donors into uninfected recipients and then treat the patients with antiviral therapy.Four years ago, 28-year-old Ana Kenney was told that she would either spend the rest of her life on dialysis or have to wait up to 10 years for a kidney transplant.

Today, she has a working kidney and is off dialysis, thanks to a new organ transplant program at the University of Alabama at Birmingham. Doctors at UAB are now able to safely transplant organs from hepatitis C-positive donors into uninfected recipients and then cure the hepatitis C with antiviral therapy.

This has allowed more organs to be transplanted, helping patients get transplanted sooner and enabling more people to lead healthier and longer lives. In the past, organs from hepatitis C-positive donors were available only for hepatitis C-positive recipients, which led to many organs being discarded as they could not be used.

In October, UAB began transplanting kidneys and livers from infected donors into uninfected patients. The recipients are told ahead of time that the organ is from a hepatitis C-positive donor and that they will have to be treated for the illness after the transplant. If the patient agrees to accept an organ from a hepatitis C-infected donor, the transplant candidate will receive the transplant and immediately start the three-month treatment.

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Added Bonus Cost Savings

An additional bonus to treating patients for hepatitis C before they receive a hepatitis C organ is cost savings. Treating transplant patients who acquire hepatitis C is expensive. The anti-viral drugs cost about $26,000 or more per patient, and often trigger delays or denials in insurance coverage.

Treating transplant recipients beforehand, thereby avoiding transmission, is cheaper. Just $3,000, according to VCU-led research under peer review.

In effect, using our strategy for the last 100 transplants has resulted in a cost savings of $2.3 million to payers, said Gaurav Gupta, M.D., Hume-Lees medical director of kidney transplantation and a lead author on the research series.

Hepatitis C And Kidney Transplantation

Transplanting Hepatitis CPositive Kidneys Appears Safe ...

James Neuberger

1Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK

2Department of Nephrology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK

Academic Editor:

Abstract

Hepatitis C virus infection is relatively common among patients with end-stage kidney disease on dialysis and kidney transplant recipients. HCV infection in hemodialysis patients is associated with an increased mortality due to liver cirrhosis and hepatocellular carcinoma. The severity of hepatitis C-related liver disease in kidney transplant candidates may predict patient and graft survival after transplant. Liver biopsy remains the gold standard in the assessment of liver fibrosis in this setting. Kidney transplantation, not haemodialysis, seems to be the best treatment for HCV+ve patients with ESKD. Transplantation of kidneys from HCV+ve donors restricted to HCV+ve recipients is safe and associated with a reduction in the waiting time. Simultaneous kidney/liver transplantation should be considered for kidney transplant candidates with HCV-related decompensated cirrhosis. Treatment of HCV is more complex in hemodialysis patients, whereas treatment of HCV recurrence in SLK recipients appears effective and safe.

1. Introduction

Prevalence of Hepatitis C Infection. Data source: World Health Organization.

2. Natural History of Hepatitis C Virus Infection

3. HCV Infection in End-Stage Kidney Disease : Prevalence and Impact on Survival

Cohort Size
1.25.04

10. Conclusion

References

Copyright

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Opioid Overdoses A Bittersweet Source Of Donor Organs

The increased supply of donor organs from hepatitis C patients is driven in part by the opioid epidemic, Gupta said. Overdoses cause deaths in an otherwise healthy person, whose organs would generally be considered safe for transplant. Sharing needles, though, can transmit hepatitis C.

Theres sadly been a huge surge of organs lungs, hearts, livers, kidneys that have become available for transplant due to the opioid pandemic, Gupta said.

Currently, researchers are looking at ways to change preventative drugs to drop the risk of transmission to zero. Gupta is also looking at long-term outcomes to understand whether there are any consequences to the treatment. We don’t believe so, he said. But thats what we do in science measure things that may not have been accounted for before.

Can People Donate A Kidney If They Have Hepatitis C

It is possible for individuals with HCV to donate healthy kidneys, either during their lifetime or after they die. However, it depends on the health of their kidneys.

Previously, people with HCV could not donate kidneys, but this has changed with the availability of direct-acting antiviral drugs. These drugs offer cure rates above 95% for people who have contracted the virus and also have chronic kidney disease or end stage renal disease.

There is a high demand for organ donors in the U.S., so a doctor may recommend using a healthy kidney from an HCV-positive donor and then treating the recipient with DAAs after the transplant surgery.

Some evidence indicates that HCV-positive individuals who receive kidneys from HCV-positive donors have than people who receive a kidney from HCV-negative donors. However, they have a shorter waiting time, which can be lifesaving.

People with HCV are not eligible for kidney donation if they have any kidney damage or disease.

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Can People With Hepatitis C Receive A Kidney Transplant

Individuals living with hepatitis C can receivea kidney transplant, but a medical team will need to consider the risks and benefits of the procedure.

For example, if a person with hepatitis C has significant liver damage, it may be unsafe for them to undergo transplant surgery. However, if they can receive a liver and kidney transplant at the same time, this may make receiving a new kidney possible.

New Life For Kidneys That Are Often Discarded

Kidney Transplant in Patients with Hepatitis C: The Elliott Stevens Story

Traditionally, kidneys from hepatitis C-positive patients have been discarded to avoid transmitting hepatitis C to the transplant recipient. Now that there is a treatment for hepatitis C, some transplant centers do use these kidneys. After transplant, they immediately treat recipients with eight to 12 weeks of anti-viral drugs to eradicate the disease, which is transmitted with the new kidney.

In contrast, at VCU Health Hume-Lee Transplant Center, recipients receive the anti-hepatitis drugs prior to surgery, rather than afterwards. The thinking: prevent transplant recipients from getting hepatitis C in the first place.

Since the initial yearlong trial in 2018, Hume-Lee has successfully transplanted more than 150 kidneys from hepatitis C-positive donors without transferring chronic hepatitis C to the recipients.

We can reassure patients that there is a very low likelihood they will ever get hepatitis C, Gupta said. That helps a lot on the emotional side because most families, particularly spouses, are very concerned that their loved one will get the infection.

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Clinical Trials Versus The Real World

Although both the THINKER trial and the EXPANDER-1 trial offered encouraging results, they left many questions to be answered before this strategy could be considered standard of care. Both of these studies were performed in a strict research setting, which included reliable and early availability of DAAs coupled with the close monitoring that accompanies a clinical trial. Both trials were industry funded with provision of DAA medications, and no third-party payers were involved. In a real-world setting, rapid access to DAAs may not be easily achievable because these drugs are only FDA approved for the treatment of chronic and not acute HCV infection. There is a possibility that approval from third-party payers could be delayed if the case must be appealed and reviewed.

Getting A Kidney Transplant When You Have Hepatitis C

You can still be eligible to get a kidney transplant if you have hepatitis C. When you have hepatitis C, your transplant team will consider the health of your liver:

  • If your liver is badly damaged, you may not be recommended for a kidney transplant.
  • In certain cases, if your liver is damaged but you are healthy otherwise, you may be considered for a kidney and liver transplant at the same time.

If you are approved for transplant, your doctor might suggest you get a kidney from a person with hepatitis C or from a person without hepatitis C.

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Getting A Kidney From A Person Without Hepatitis C

You would stay on the regular waiting list for a kidney transplant and be treated for hepatitis C before the transplant surgery.

In the past, treatment for hepatitis C could cause problems for the new transplanted kidney. Now that new medicines for hepatitis C have been created, this is less of a problem. Work with your doctor to decide which medicines for hepatitis C are best for you if you are considering, or have had, a kidney transplant.

What Is The Impact On The Person Receiving The Transplant

Hepatitis C

In most cases, kidney transplantation significantly improves an individuals quality of life. A person who receives a new kidney may no longer require dialysis and can return to a more normal life.

However, kidney transplantation is not a cure for chronic kidney disease, and the individual must take medications for the rest of their life. As a result, they may still experience some physical and mental health challenges.

A persons HCV status may also affect their life expectancy following a transplant. In an earlier , doctors found that HCV-positive people have a 5-year survival rate of 77% following a transplant compared with 90% of HCV-negative patients.

However, this survival rate in transplant recipients with HCV is

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Transplanting Hepatitis Cpositive Kidneys Appears Safe And Effective

A recent study found that transplanting such kidneys and then treating the recipient for hep C worked well.

    People waiting for a kidney transplant may do well to receive such an organ from a donor with hepatitis C virus , MedPage Today reports. A recent small study found that doing so and then treating the recipient with direct-acting antivirals was safe and effective.

    Publishing their findings in the Annals of Internal Medicine, researchers conducted a study of 20 HCV-negative individuals who were awaiting a kidney transplant. They received kidneys from 15 different HCV-positive donors. Ten of the participants were enrolled in the THINKER-1 study, and the other 10 were enrolled in the EXPANDER study.

    After they received their kidneys, most of the participants were treated with 12 weeks of Zepatier. Three of the participants had hep C with mutations associated with resistance to NS5A inhibitor DAAs, so they received 16 weeks of Zepatier plus ribavirin according to protocol. All participants were treated with standard immunosuppression therapy to prevent rejection of their new organ.

    All participants achieved a sustained virologic response 12 weeks after completing DAA therapy .

    As for creatinine levels , six months post-surgery the results for both HCV-positive and -negative individuals were a respective 1.2 and 1.2 milligrams per deciliter. Twelve months post-surgery the results were a respective 1.1 and 1.1 mg/dl.

    To read a press release about the study, .

    Demographic And Clinical Data

    Patients were asked for demographic information , waitlist time, dialysis time, type of dialysis, and history of a prior kidney transplant. Patients were also asked if they had been diagnosed and/or treated for HCV and if they had any personal contacts with known history of HCV. They were then asked to respond to three hypothetical kidney offers as follows: 1) 20-year-old HCV-infected donor with a greater than 95% chance of successful HCV cure following transplant 2) 20-year-old PHS-increased risk donor with active IVDU at time of death and 3) 70-year-old donor with long-standing hypertension and diabetes. For those patients who reported no to any organ offer, they were then asked to indicate how much additional time they would be willing to remain on the transplant list in order to receive a standard kidney offer. Finally, patients were asked if added costs or doctor visits for HCV treatment were of concern to them. A full copy of the survey is included as Additional file .

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    Daas In The Treatment Of Hcv Infection Post

    Following the discovery of HCV and the availability of an ELISA to identify anti-HCV antibody, many cases of transmission of HCV with kidney transplantation were reported . Adverse consequences of transmission at the time of transplantation with resulting de novo HCV infection in the setting of intense immunosuppression included an aggressive form of fibrosing cholestatic hepatitis and an immune complex injury to the allograft resembling membranoproliferative GN . The use of kidneys from HCV-infected donors was discouraged, and to a great extent, these kidneys were either not retrieved or discarded .

    Kidney Transplantation From A Hepatitis C Virusinfected Donor Into An Uninfected Recipient: Ready For Prime Time

    Hepatitis C-infected kidneys reduce wait time for transplants
    • Javier PaganAffiliationsKatz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA
    • David RothCorrespondenceCorrespondence: David Roth, Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 813, Miami, Florida 33136, USA.AffiliationsKatz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA

    Am J Transplant.

      N Engl J Med.

        Semin Dial.Am J Transplant.Ann Intern Med.

          • Brown D.M.
          • et al.

          Ann Intern Med.KI Reports

          • Chute D.F.
          • et al.

          Kidney Int Rep.

            preemptive

                standard of careHCV-positive statuset al.

                  et al.HCV status

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                  New Protocols Benefit Underserved Communities

                  The VCU research, funded by the VCU Presidential Research Quest Fund, VCU Health Pharmacy Services and Gilead pharmaceuticals, is also improving care and addressing social inequities: most kidney transplants at VCU are performed on African American and Latino recipients a number are low income. Both groups are multiple times more likely to experience kidney failure than whites.

                  Essentially the bulk of these hepatitis C transplants at VCU are going to historically disadvantaged populations and providing them very good outcomes, Gupta said. From both a cost and care perspective, this research has helped us serve minority communities a lot more than we would have been able to in the past.

                  For more information about kidney transplantation at VCU Health Hume-Lee Transplant Center, visit vcuhealth.org/transplant.

                  What Is The Procedure

                  Before individuals can undergo a kidney transplant procedure, they must find a suitable donor who fits their specific health criteria. A donor can be an individual who has recently died and stipulated their wish to donate a kidney, or it can be a living donor who wants to give a kidney to the person in need.

                  Following a doctors identification of a suitable donor, a kidney transplant from a live donor usually involves the following steps:

                • A doctor will admit the recipient and donor to the hospital. Both will undergo tests, such as physical examinations, blood tests, and X-rays, to confirm their health and suitability.
                • Medical staff will shave the chest and abdomen to remove any hair in preparation for the surgery. They will also insert IV lines.
                • A doctor will administer a general anesthetic to put both people to sleep. They may also use a local anesthetic at the site where the surgeon will make their incision.
                • A surgeon will make an incision in the donors abdomen, remove the kidney for donation, and close the wound.
                • They will then make an incision in the recipients abdomen, through which they will place the donated kidney. They will attach essential blood vessels and the ureter to connect the kidney to the bladder.
                • With donations from deceased individuals, the procedure for the recipient is much the same. Instead of taking the kidney from a live donor, doctors carefully chill and package a kidney from a recently deceased donor and transport it to the hospital.

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