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Researchers from Johns Hopkins have figured out a way to cure kidneys infected with hepatitis C, which would allow them to be used for dialysis patients in desperate need of a transplant.
In a small study, 10 kidney patients were treated before transplant surgery with an antiviral medication that prevents hepatitis C from replicating in the body, and continued receiving treatment for 12 weeks after transplant, according to Dr. Niraj Desai, director of the kidney and transplant program at Johns Hopkins University in Baltimore. The patients in the study were very sick and had already spent years waiting on a kidney transplant. They all had a diagnosis of stage 5 chronic kidney disease and there were no viable living donors.
The trial was risky for the patients — they would get a much needed kidney, but could be infected with the disease and live with it for the rest of their lives. During the program, the patients were continuously monitored with a blood test to measure how much of the hepatitis C virus was in their blood.
The gamble paid off. All 10 patients cleared the virus after taking a 12-week course of the oral medication, Zepatier, donated by Merck which funded the study.
"This doesn’t solve our kidney shortage problem, but it has the potential to enable 500 to 1,000 more people to get kidney transplants [annually], just based on how many organs are being discarded now," said Desai.
Of the 10 patients, five displayed an undetectable viral load from the disease just after surgery; after 12 weeks of treatment, none of the 10 showed any sign of the disease.
"Historically, hepatitis C-infected kidneys were discarded. In fact, more than half of hepatitis C-positive kidneys are discarded per year because they are thought to be damaged or too 'high-risk',” said Desai.
Hepatitis C is a viral infection that causes inflammation of the liver and can lead to serious liver damage. It spreads through contaminated blood, most often through intravenous drug use. At least 3.2 million Americans are living with chronic hepatitis C infection and most don't know it. And with the ongoing opioid epidemic, the numbers of hepatitis C-infected donor organs may be growing as well, experts say.
"Because there is a number of young, otherwise, healthy people dying of drug overdose, there’s this large pool of donors with hepatitis C whose organs are available for transplant,” said Desai.
The new study, published Monday in the Annals of Internal Medicine, comes on the heels of a 2017 University of Pennsylvania trial using the same drug. In the previous study, UPenn researchers successfully used the antiviral medication on transplant patients after surgery.
"Because there is a number of young, otherwise, healthy people dying of drug overdose there’s this large pool of donors with hep C whose organs are available for transplant."
Currently in the U.S. there are over 95,000 people on the kidney transplant waiting list. The wait for a deceased donor could be five years, and in some states, as long as 10 years. Patients are prioritized by how long they’ve been on the waiting list, their blood type, immune system activity and other factors. Four out of five people on the waiting list are on kidney dialysis and the longer a person is on dialysis and has to wait for a transplant, the lower their chance of a successful transplant.
On average, receiving a kidney transplant can double someone’s life expectancy.
“A patient who probably would have waited four or five years for a transplant can get one in less than a month," Dr. David S. Goldberg, medical director for Living Donor Liver Transplantation at the Hospital of the University of Pennsylvania told NBC News in 2017.
Next, the Johns Hopkins researchers want to conduct larger trials for kidney patients, as well as new clinical trials transplanting hearts and lungs donated by people with the virus.
“Hepatitis C is curable now and we need to take a step back and really see this as an untapped supply of donors that can save hundreds if not thousands of lives,” Goldberg said.