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The patient James Sullivon, who received a heart transplant for hepatitis C, received an antiviral drug shortly after the procedure in the hope of blocking hepatitis infection C rather than treating it.
(AP)
WASHINGTON – Doctors can safely transplant hepatitis C-infected lungs and hearts to people who are desperately looking for a new organ, say researchers who may have found a way to protect these patients from cancer. virus infection.
The experiment, reported Wednesday, is the latest attempt to reduce the country's long waiting list by using organs that would otherwise be lost, often those of victims of the opioid epidemic.
The new twist: Instead of trying to cure hepatitis C after its implantation in transplant recipients, researchers at Brigham and Women's Boston Hospital claim that a faster treatment and less dear seems to prevent the infection.
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"It's not about throwing out the proper organs for medicine," said Dr. Ann Woolley, Brigham's Infectious Disease Specialist, co-author of the New England Journal of Medicine study. .
Transplanting organs that may infect someone with a virus that is damaging to the liver may seem dramatic, but the shortage of organs has more hospitals to try. More than 113,000 people are on the national waiting list for a transplant; only 36,529 people had one last year. About 1,000 people die each year while waiting for a heart or lung transplant.
"I knew that time was shortening for me," said Rexford Kelley, 71, of Searsport, Maine. He therefore consulted the Brigham study in the hope that accepting a lung infected with hepatitis C would mean a faster transplant. "I'm grateful to have the lungs," said the retired state soldier, who now breathes easily enough to regain the golf course.
Until recently, doctors tended to transplant organs infected with hepatitis C only in patients already carrying this virus.
But in 2016, driven by powerful new drugs promising to cure hepatitis C, surgeons have begun experimenting with what's called mismatched transplants – giving infected kidneys to recipients free of the disease. hepatitis. If these patients showed signs of infection, they have three months of drugs to repel it. Last year, small studies conducted at the University of Pennsylvania and Johns Hopkins University showed that not only were patients cured of their hepatitis, but that the new kidney was functioning well.
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It was time to test lung transplants or rarer hearts. Among the questions: would hepatitis C make it more difficult to transplant these more fragile organs? And as hepatitis drugs cost tens of thousands of dollars, could patients also benefit from shorter, less expensive treatment?
In February, Penn researchers announced that the standard three – month treatment had cured 10 people suffering from a heart infected with hepatitis C. One of them eventually died from the rejection of organ but the others were fine.
Brigham researchers have taken a different approach. A few hours after a heart or lung transplant, participants started taking medication for a month in the hope of blocking hepatitis C infection rather than treating it.
The study showed how about half of the 69 people transplanted are coming out of it so far. Six months after the transplant, none showed signs of hepatitis C and their organs worked well. One of them died eight months after the transplant of a non-hepatitis-related bacterial infection, but 15 are doing well a year later.
Woolley said the researchers could test an even shorter treatment, noting that the virus was undetectable at two weeks.
It could work "because the virus may not have had the chance to establish itself," said Peter Reese, Penn's kidney specialist, who helped the pioneer in Hepatitis C disease transplantation but did not participate in the latest research. But, "If the short program does not work, it's important to make it clear to patients what they would do."
Larger and longer studies are essential for all hepatitis C-infected transplants, Reese added.
Many hospitals do not expect more evidence. Last year, there were 1,274 hepatitis C-infected transplants in virus-free people, compared with several hundred the previous year, according to the Unified Network for Sharing Viruses. organs, which oversees the country's transplant system.
"It has not been established that cure rates are 100%," warned Dr. David Klassen, UNOS Medical Officer. "To believe him would be a little naive."
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But a Penn heart recipient said patients should know that this option could reduce their waiting time. Tom Giangiulio Jr., 59, from the Township of Waterford, New Jersey, was progressively deteriorating after two years of waiting for a transplant when the doctors asked him if he would be the first volunteer in their study. . It was grafted in June 2017.
"My first thought saved my life," he recalls. My next thought was, "I'm the favorite here. What I am doing could open an incredible number of hearts to other recipients. "
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