PHOENIX — Since 2016, kidneys from donors with hepatitis C virus are being discarded less and transplanted more, according to a speaker at Cutting Edge of Transplantation: Transplant Summit.
“In 2018, I had a heart transplant and chose an organ that was hepatitis-C positive,” Robert Montgomery, MD, DPhil, FACS, of NYU Langone Transplant Institute, told the audience. “As someone who has been involved in the development of this field, I was very comfortable with the risk and I believe in moral alignment. I wouldn’t ask my patients to do something that I wasn’t willing to do myself.”
Furthermore, he added, “I have trouble thinking about competing with our patients for an organ. The idea of using an organ that might be discarded was very appealing to me.”
Outlining the trajectory of transplantation with HCV-viremic kidneys, Montgomery pointed to the opioid crisis which, he claimed, contributed to more deaths than car accidents in the United States in 2018. Due to these deaths from overdose, there were significantly more deceased donors with hepatitis C than uninfected recipients in need of transplant, and discard rates for infected kidneys reached 50% in 2016, he said.
Direct-acting antivirals have been proven successful in treating hepatitis C, according to Montgomery, and so there have recently been trials examining the impact of transplanting such organs. He said patients became viremic in the first few days after transplant, but cleared their virus within a month. In addition, patients experienced less time on the waiting list.
“From a waitlist perspective, hepatitis-C organs are becoming more like any other organ, as the use of more distressed organs is expanding,” Montgomery concluded. “We’re utilizing the vast majority of these organs now, not only completely ideal ones. The discard rate is very low.” – by Melissa J. Webb
Montgomery R. Effect of hep C treatments on access to transplantation and equity to hep-C + and – candidates. Presented at Cutting Edge of Transplantation: Transplant Summit. March 5-7, 2020; Phoenix.
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