Direct acting antivirals expand organ donation

Infectious diseases

By Mardi Chapman

22 May 2018

A surge in deaths from the opioid crisis in North America has expanded the potential pool of relatively young organ donors with excellent lung function – if transplant centres are prepared to use hepatitis C positive donors.

Dr Marie Budev, from the department of pulmonary medicine at the Cleveland Clinic, told ATS 2018 that hepatitis C infected donor organs were generally not considered in the past due to the high probability of virus transmission.

However since DAAs had made hepatitis C largely curable, the potential existed to transplant infected organs then treat the recipients.

She said experience from other types of organ transplants including kidneys, suggested it was feasible.

Dr Budev highlighted a recent Canadian case series of five lung transplants from HCV viraemic donors to HCV negative recipients.

Four of the five donors were women under the age of 40 with a history of injecting drug use and other high-risk behaviours.

Recipients were rapidly deteriorating and had only small windows of remaining transplant eligibility.

Dr Budev told the conference that all recipients had high viral loads soon after transplant.

DAA treatment was initiated between 24 and 94 days after lung transplantation when patients were clinically stable and could tolerate the course of oral antiviral medications.

All five patients achieved a sustained viralogic response and were alive at 9-12 months follow-up.

“Although no recipients developed HCV or DAA-related adverse effects, all had complicated post-operative courses mainly attributable to the severity of their underlying condition pre-transplant,” the study said.

While the small series shows that HCV positive donor lungs can be transplanted to non-infected recipients with a favourable outcome, Dr Budev said it raises some ethical issues about the intentional transmission of an infectious disease.

There is also a question about whether the antivirals would be reimbursed under such an arrangement.

More research was also required regarding an impact of viraemia on the development of de novo donor-specific HLA antibodies and allograft function long-term.

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