Successful transplantation reported of hepatitis C kidneys into patients without hepatitis C

Issue: April 2018

Surgeons at Johns Hopkins University Hospital have successfully transplanted 10 hepatitis C-infected kidneys into patients without hepatitis C and prevented the patients from becoming infected with the virus.

“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,” Niraj Desai, MD, an assistant professor of surgery at Johns Hopkins University School of Medicine and senior author on a paper published in Annals of Internal Medicine detailing the cases, said in a press release.

“Figuring out how to use these kidneys is a way to do more transplants and save more lives.”

Around 500 hepatitis C-positive kidneys are discarded from organ donors in the U.S. every year, Desai said in the release, because of the risk of infecting recipients. He and his colleagues thought it was time to try taking advantage of the new drugs to pave the way for using hepatitis C-positive kidneys for transplants.

“In this era of organ shortages, it’s difficult to watch good organs get discarded,” Christine Durand, MD, an assistant professor of medicine at Johns Hopkins University School of Medicine and study co-author, said in the release. “This was a great opportunity to take a neglected public health resource and put it to good use.”

Desai and Hopkins colleagues approached patients older than 50 years who were awaiting kidney transplants, had no previous transplants and no available living donors, and were negative for hepatitis C, as well as HIV and hepatitis B. Ten patients agreed to receive hepatitis C-positive kidneys. Their average age was 71 and they had been on the transplant waiting list an average of 4 months. All donor kidneys were recovered from donors aged 13 through 50 years, tested positive for hepatitis C and showed no evidence of kidney disease. The donors’ blood was tested for strain and quantity of hepatitis C virus.

“These 10 kidneys we used are 10 kidneys that would not have been transplanted outside of this study,” Desai said. “They would have been discarded.”

Each recipient received a dose of grazoprevir/elbasvir, an oral combination pill, while they were waiting to go into the OR for their transplant. Each recipient then continued taking a daily pill of grazoprevir/elbasvir for 12 weeks after transplantation. Three patients also took a daily dose of sofosbuvir due to the strain of hepatitis found in their donor organ.

In five of the kidney recipients, there was never any hepatitis C RNA detected in their blood. In the other patients, low levels of the virus were detected shortly after transplant but then became undetectable within days or a week, according to the release. No recipients ever developed any clinical signs of chronic hepatitis C infection. In addition, the kidneys themselves functioned well. At the time of the study’s publication, all patients are at least a year out from their transplant and doing well, Desai said.

“This was an overwhelmingly positive study,” Durand said in the release.

The researchers said they would next like to see their results replicated in a larger, multicenter trial. They say if the success of the transplants continues, it could pave the way for other hepatitis C-positive organs, including hearts and livers, to be transplanted as well.

“We’re always trying to expand what we consider acceptable for an organ donor,” Durand said in the release.

Disclosures: Durand reports she has received research grants from Bristol Meyers Squibb, Gilead Sciences, Merck Pharmaceuticals and Viiv Healthcare, and she has served as a scientific adviser for Bristol Meyers Squibb, Gilead Sciences and Merck Pharmaceuticals. Desai reports he has served as a scientific adviser for Merck Pharmaceuticals. Please see the full study for all other authors’ relevant financial disclosures.