Kidneys from deceased donors with hepatitis C virus (HCV) infection can be safely transplanted into noninfected receivers when a regimen of direct-acting antiviral therapies is initiated as early as 2 days after the transplant, according to a study from Massachusetts General Hospital (MGH). In a multi-center scientific trial reported in the Journal of the American Society of Nephrology, MGH researchers found that each of 30 kidney receivers were cured of HCV without any major side effects attributable to the antiviral treatment, which almost all preserved outstanding allograft function at six months.
” We effectively dealt with the hepatitis C virus in kidneys transplanted from HCV-positive donors by utilizing the antiviral representatives glecaprevir and pibrentasvir as part of an eight-week course of day-to-day dosing,” says Meghan Sise, MD, private investigator in the Department of Nephrology at MGH and co-first author of the study. “These findings might carry a strong message to the numerous transplant centers that are still cautious about or resistant to utilizing kidneys from HCV-infected donors.
Nearly 95,000 individuals in the U.S. are presently waiting for kidney transplant, the majority of suffering progressive health degeneration. For some groups, consisting of patients over 60, death is a higher certainty than a transplant. Provided this considerable public health problem, the U.S. Department of Health and Human Solutions set a goal of doubling the variety of kidneys readily available for hair transplant by 2030 as part of the Advancing American Kidney Health Initiative. One promising path towards that target is minimizing the discard of viable human kidneys that now happens, particularly from deceased individuals with hepatitis C virus infection. The variety of those organs has actually soared over the previous five years as a result of installing deaths from the national opioid epidemic.
The MGH potential trial is the very first multi-center investigation to reveal the expediency of donor favorable to donor negative transplantation. Known as MYTHIC (Multi-Center Research Study to Transplant Hepatitis-C Infected Kidneys), the research study was developed and carried out in partnership with the Perelman School of Medicine at the University of Pennsylvania. Each of the trial’s 30 kidney recipients at seven U.S. transplant centers was provided an eight-week course of a coformulation of glecaprevir and pibrentasvir, powerful antiviral agents that target 2 distinct proteins within the virus that are vital to its survival.
While one patient died of complications of sepsis considered unassociated to trial participation, no severe negative effects or liver disease were observed in any client, and allograft function at 6 months was outstanding. “A number of the patients showed a tiny amount of infection in their blood right after transplant, however that viral load became undetectable or unquantifiable in all receivers of HCV-viremic kidneys by four weeks of treatment,” notes Raymond Chung, MD, private investigator in the Liver Center and Gastrointestinal Division at MGH and co-senior author of the study.
The trial’s success extends to the advancement by the research study group of an evidence-based scientific protocol for transplanting hepatitis C-infected kidneys that might be used by transplant centers anywhere.
Scientists are now hopeful that transplant centers will take notice of these encouraging results and the opportunity they manage to increase access to high quality organs by clients in vital requirement of a kidney transplant. “By showing that these treatments work,” states Sise, “we’re hoping that insurance companies will likewise see the huge benefit of making transplants with hepatitis-C contaminated kidneys evenly covered and reimbursable. The supreme objective of everybody should be to increase the quality and quantity of life for patients waiting on a kidney transplant.”
Sise is also a nephrologist and assistant professor of Medicine at Harvard Medical School. Chung is director of Hepatology and the Liver Center at MGH. The study group also included MGH authors Winfred Williams, MD, Nahel Elias, MD, Jenna Gustafson, MS, and co-lead author David Goldberg, MD and, from University of Pennsylvania, co-senior author Peter Reese, MD.
The research study was supported by the biopharmaceutical business AbbVie.