Hepatitis C cure may open door to more kidney transplants

Last Updated: 2017-05-01

By Gene Emery

NEW YORK (Reuters Health) - Kidneys infected with hepatitis C have been successfully transplanted into 10 patients and then cleansed of the virus.

The pilot study, reported April 30 at the 2017 American Transplant Congress in Chicago and online by the New England Journal of Medicine, could open the door to many more transplants, which cost far less over the long term than dialysis.

Hepatitis C patients have been traditionally excluded from donating organs. But that was before development of the drug combination of elbasvir and grazoprevir, commonly known as Zepatier, which usually eliminates the infection.

"This trial shows how the whole face of hepatitis C has completely changed in the last few years. It used to be a disease we dreaded and all the options were terrible," study coauthor Dr. Peter Reese told Reuters Health by telephone.

For kidney-transplant recipients, there was concern that the immunosuppressive drugs given after a transplant might interfere with the ability to eliminate the hepatitis C virus and they might have to deal with the complications of the virus for the rest of their lives. In fact, by the third day after transplantation, all 10 had detectable levels of the virus in the blood.

But after the standard 12-week regimen of Zepatier, all traces of the virus had disappeared and remained absent for an additional 12 weeks.

"For these patients, getting off of dialysis and getting back to their normal lives was very much worth the risk,�€ Dr. Reese said.

Merck, which markets the drug combination, helped pay for the trial.

The treatment costs about $54,600, but just as an expensive kidney transplant saves money in the long run, adding the hepatitis C treatment should still be cost effective, said Reese, an assistant professor of medicine and epidemiology at the University of Pennsylvania and chairman of the ethics committee for the United Network of Organ Sharing.

"These drugs are expensive. But we know a lot of companies have similar drugs in the pipeline that will have to compete with existing ones, so I anticipate the costs will fall," he said. "I believe using these hepatitis C treatments might still make kidney transplantation a very financially competitive option compared to dialysis."

With about 12,000 kidney transplants from deceased donors done per year and 97,000 people waiting for a kidney, it's not clear how many extra cases can be done even if follow-up tests confirm that the hepatitis C therapy can safely increase the donor pool.

The University of Pennsylvania authors said more than 500 high-quality kidneys are discarded each year because they are infected.

"It's plausible that the number is higher than that because we know a lot of organ procurement organizations don't vigorously pursue hepatitis C-positive organs," said Dr. Reese. "I don't want to make the claim that this will solve the organ crisis. It will not. But 500 is probably the floor."

The therapy might also work for other transplanted organs, he said. But for now, the researchers have approval to test it on 10 more people waiting for a kidney transplant "to show this can be reproduced in larger numbers in other centers with more permissive criteria," Dr. Reese said.

The study, known as THINKER, only used donors infected with hepatitis C genotype 1, the most common type of infection. Elbasvir-grazoprevir treatment was begun as soon as the recipient showed evidence of the virus. The volunteers will be followed for one year.

SOURCE: http://bit.ly/2oVtsrj

N Eng J Med 2017.