Locations:
Search IconSearch
April 24, 2018/Digestive/Transplant

Hepatitis C Organ Transplant Program Expands

Effective HCV treatments enable transplantation of HCV-positive organs to HCV-negative patients

Hep-C-CQD

Donated organs for transplantation are always in short supply: As of July 2017, 116,830 U.S. patients were awaiting solid organ transplantation: 98,856 needing kidneys and 14,176 livers. However, only 17,157 transplants were performed last year. “The big issue is that people die while waiting for an available organ,” says K.V. Narayanan Menon, MD, Medical Director of Liver Transplantation.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Fortunately, one new source of organs has become available: hepatitis C (HCV) infected organs. The number of these organs has increased in recent years, most likely due to the opioid epidemic. Since 2013, multiple direct-acting antiviral agents (DAAs), which are associated with high HCV cure rates and minimal side effect profiles, have been approved by the Food and Drug Administration (FDA). As a result, HCV-infected organs have been increasingly used in transplants.

How it works in practice

Cleveland Clinic began by treating all historical transplant patients who had HCV with DAAs; the drugs cured the virus with no negative interactions with anti-rejection medications. “DAAs have revolutionized our perspective on the hepatitis C virus: It was once difficult to manage and control and now it is easily treated,” says Bobby Zervos, DO, Medical Director of Liver Transplantation at Cleveland Clinic Florida.

Next, HCV-positive kidney transplant candidates were treated with DAAs before transplantation to clear the virus, due to concern over HCV possibly causing kidney dysfunction. Again, the drugs were effective and eventually led to a change in practice by transplanting HCV-infected organs into HCV-positive recipients. Outcomes were once again beneficial with no drug interactions with immunosuppressive regimens.

In January, Cleveland Clinic began offering HCV-negative transplant candidates the option of HCV-infected organs after spending a year developing their carefully outlined protocol. Overall, the response has been positive, reports Dr. Menon, with some patients understandably cautious, given the negative media coverage of HCV. “Hepatitis C organ transplantation is especially useful in patients who are symptomatic with liver disease but don’t have a score for immediate transplant,” says Dr. Menon.

Advertisement

Program results so far

To date, 44 HCV transplants, which include liver, kidney and heart, have been performed at Cleveland Clinic facilities nationwide. “We have a safe and innovative way to provide access to a limited resource and expand the donor pool and provide quality outcomes for our transplant patients,” says Dr. Zervos.

When the HCV virus is detected in patients’ blood, which often is detected within three days post-transplant, DAA treatment is started as soon as feasible and continues for 12 to 16 weeks. Patients who have past exposure to Hepatitis B infection are monitored for reactivation during therapy.

While DAA cure rates are 98 percent or better, HCV transplantation is not without risks. The consideration of HCV positive organs to negative recipients must carefully be reviewed case by case to ensure that the patients transplant benefit to virus exposure outweigh the risks. These risks vary organ to organ and thus a multi-disciplinary approach in protocol development was thoroughly vetted with all Cleveland Clinic organ transplant specialists involved.

So far, all Cleveland Clinic HCV transplant patients have responded well to DAA treatment with no adverse interactions with transplant medications. Positive outcomes have also been reported in studies of HCV transplantation: In a University of Pennsylvania single-group, pilot trial of 10 HCV-negative patients who received HCV-infected kidneys, all developed HCV and were cured after 12 weeks of DAA treatment. Also, in a Johns Hopkins School of Medicine nonrandomized trial of 10 HCV-negative patients who received HCV-infected kidneys, DAAs were administered immediately before and for 12 weeks following transplantation. Again, all patients had positive outcomes.

Advertisement

“Now that we have effective HCV treatments, it’s likely that HCV transplantation will become as routine as transplantation with organs from previously exposed hepatitis B virus or cytomegalovirus (CMV),” says Dr. Menon.

Advertisement

Related Articles

Federico Aucejo, MD
February 7, 2024/Digestive/Transplant
New Research Indicates Liver Transplant, Resection as an Option for Patients with CRLM

ctDNA should be incorporated into care to help stratify risk pre-operatively and for post-operative surveillance

22-DDI-3110663 LDLT 640×450
March 1, 2023/Digestive/Transplant
Advanced Surgical Techniques Achieve Success with Small-Size Grafts in Living Donor Liver Transplantation

Program's approach maximizes donor safety without compromising recipients' outcomes

650×450-Kwan-Liver-Transplant
March 16, 2021/Digestive/Transplant
How to Build a Successful Laparoscopic Living-Donor Hepatectomy Program

Cleveland Clinic’s team reviews progress and offers guidance

Florida-690×380
October 14, 2015/Digestive/Transplant
Program Update: Liver Transplantation at Cleveland Clinic Florida

Exponential growth, complex cases, shorter wait times

Closeup of physician performing bariatric surgery
October 8, 2024/Digestive/Research
Consider Weight Loss Surgery as a Treatment for Chronic Kidney Disease, Obesity

Findings show greater reduction in CKD progression, kidney failure than GLP-1RAs

Physician speaking with patient
The Mind-Gut Connection: How Behavioral Health Specialists Improve GI Care at Cleveland Clinic

Customized interventions for diverse GI disorders are enhancing patient outcomes

Pills in packaging
September 9, 2024/Digestive
Functional Dyspepsia: How to Manage the Burn and the Bloat (Part II)

Guidance on medications and treatment options

Ad