A group of transplant surgeons at Brigham and Women’s Hospital in Boston decided to investigate whether organs from donors with the hepatitis C virus (HCV) could be safely transplanted into recipients without the virus. They reported their findings in the New England Journal of Medicine.

Hearts and lungs from donors infected with HCV are usually discarded out of concerns of spreading the viral infection, despite the immediate need for such organs. Depending on the patient’s condition and the availability of organs at the time, patients may not be able to wait for an organ.

In fact, more than 12,225 were removed from organ waiting lists in 2018 alone because of death or a progressive illness that rendered the patients too ill to undergo transplantation.

In many areas of the country, drug users account for a large proportion of organ donors. In some states, one-third of donor organs come from IV drug users. Study organizer Dr. Ann Woolley of Brigham and Women's told NPR, “Over a third of all of our heart and lung transplants that we've done at our center have been from donors who had hepatitis C.”

Organs for donation increasingly carry the hepatitis C virus, as people who use inject drugs and share needles are at high risk of HCV infection. Seeing these organs go to waste frustrates doctors and patients alike, as using HCV-infected hearts and lungs can potentially bring life-saving organs to patients in time to save lives.

Fortunately, the newest antiviral drugs are so effective that they can effectively protect recipients from a variety of infections, including HCV infection. This new line of treatment may even protect organ transplants from hepatitis infections from HCV-positive hearts and lungs.

Study Investigates Benefits of Initiating Hepatitis C Treatment Immediately after Organ Transplantation

The researchers enrolled 44 patients into the study; 36 participants received lung transplants and eight received heart transplants. 61% of the donors were HCV genotype 1, 17% were genotype 2, 17% were genotype 3, and 5% were indeterminate. The median viral load in the HCV-infected donors measured 890,000 IU per milliliter (IU/mL), but the detectable HCV viral load in immediately after transplantation was 1800 IU/mL in 42 of the 44 organ recipients.

All 35 of the first participants who enrolled and who had completed six months of follow-up were alive, demonstrated excellent graft function, and had an undetectable HCV viral load at six months following transplantation. The viral load was undetectable two weeks following transplantation, and remained at undetectable levels in all participants.

None of the participants experienced treatment-related serious adverse events. More cases of organ rejection occurred in the patients receiving lung transplants than in a group of patients that received uninfected lungs during the same period, but the researchers believe the increase was statistically insignificant after accounting for other factors.

The results of this study support earlier findings from researchers at the Hospital of the University of Pennsylvania and Vanderbilt University Medical Center, who each studied HCV positive heart transplants. These two studies initiated treatment only after the patient tested positive for the virus; the Brigham and Women’s study started treatment immediately, without delays associated with testing.

The new HCV medications are active against all strains of HCV, so patients do not have to undergo testing to determine strain prior to start of treatment.

Preemptively treating recipients prior to the development of signs likely prevented the patients from infection in the first place. Preemptive treatment may have also helped patients avoid infectious and noninfectious complications.

The protocols used in these studies are still in the research phase and therefore require more investigation and careful monitoring of participants before widespread use. Questions include those regarding dosage and duration of antiviral drugs, treatment costs, the applicability to various subpopulations of recipients, and plans for long-term follow-up.