Monday, March 21, 2016

Transplanting kidneys that are infected with hepatitis C (to uninfected patients) or HIV (to already infected patients) to ease the organ shortage

Two stories, one on Hep C kidneys to uninfected patients, another on HIV kidneys to patients already infected with HIV.

Here's the first story, on transplanting Hep C infected kidneys to patients who don't have the disease:

"Transplant surgeons at two US hospitals are about to do something long considered taboo: put kidneys from donors with hepatitis C into recipients without the infection.

In first-in-the-world clinical trials scheduled to launch later this spring, independent teams from the University of Pennsylvania and Johns Hopkins University will take kidneys from deceased carriers of the hep C virus, put them into patients with renal failure, and then give them a 12-week course of an antiviral therapy in the hopes that they will emerge infection-free.

If successful, the trials could enable hundreds of transplants each year for patients who might otherwise die waiting for a kidney.
"The idea behind the two upcoming trials is to take older patients who have long waits ahead and don’t have living donors, and allow them to jump the queue — if they’re willing to take on a bit more risk.

The risk of hep C infection is deemed manageable, and ethically acceptable, thanks to the latest wave of hep C medications, which offer cure rates of 95 percent and higher.

“For a 60-year-old diabetic who doesn’t have a living donor, who hasn’t been on the wait list very long, they’re miserable on dialysis, their mortality rate is high — that person might roll the dice on this and say, ‘You know what? These drugs work, and it’s worth it to me to get off dialysis sooner,’” said Dr. Heather Morris, a nephrologist at the Columbia University Medical Center.

“Initially, we’re targeting the population that has the highest mortality risk while waiting for a transplant,” explained Dr. Christine Durand, a transplant infectious disease specialist at Johns Hopkins. But if the technique proves safe and effective, she added, organs from hep C patients might one day join the regular organ pool.

“If it was me who needed a kidney,” Durand said, “I would sign up for this.”
"Both the Penn and Hopkins studies are backed by Merck, the drug company that makes Zepatier, the latest hep C agent to hit the market. The company is supplying its $54,500-per-patient medicine for free and providing additional financial support for staff and lab tests.
Here's the story about HIV kidneys:

Hahnemann to begin transplanting organs from HIV-positive donors

"The organs would be given only to patients who also are HIV-positive and have agreed to accept them. The transplants will be part of research that will carefully monitor both the transplant and the potentially deadly disease.

Johns Hopkins Hospital in Baltimore announced last month that it would be the first to offer HIV-positive organs to HIV-positive patients on its waiting list. The advantage of such transplants is that they might reduce waiting times for HIV-positive patients and also free up other organs for patients who don't have the immune-weakening virus.

The new approach was made possible by the HIV Organ Policy Equity (HOPE) Act of 2013. Before that, it was illegal to transplant organs from people with HIV. The ban was enacted when the blood-borne virus was considered a death sentence, but now that it is so much more manageable, people who are infected often die of something else.

The Philadelphia hospital has now received permission from the United Network for Organ Sharing (UNOS) to begin what are called HIV-positive to HIV-positive liver and kidney transplants. Doctors expect that most of the transplanted organs will be kidneys and that the first case will occur this year. The hospital currently has 45 HIV-positive patients either on its waiting list for kidneys or being evaluated for transplants."

No comments: