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Post Info TOPIC: Organ Donors
Canuck


Guru

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Organ Donors
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How to get the most organs, for organ transplantations, and, how to get the most out of organs, for transplantations!

Liver, kidney, heart, orrrrr whatever!

Yet, another article about treating for HCV so as to be able to use donated hearts.

Boy, aren't we glad we have the likes of PAN Vosevi and Mav nowadays! 

 

Published in Gastroenterology

News · November 13, 2018

AASLD 2018: Preemptive Direct-Acting Antiviral Therapy Prevents HCV Infection in Transplant Recipients of HCV-Infected Hearts 

The donor pool may increase, transplant wait times decrease, and outcomes improve.

PracticeUpdate Editorial Team

November 13, 2018 - San Francisco, California - Preemptive administration of pan-genotypic, direct-acting antiviral therapy has been shown to prevent chronic infection with hepatitis C virus (HCV) in hepatitis HCV-negative cardiac transplant recipients of donor hearts infected with the virus.

This preliminary result of a single-center, proof-of-concept trial was reported at the 2018 Liver Meeting® of the American Association for the Study of Liver Diseases, from November 9 13.

Emily D. Bethea, MD, of the Massachusetts General Hospital, Boston, noted that these results demonstrate the successful use of preemptive, direct-acting antiviral therapy in the setting of cardiac transplantation. This novel approach may lead to an increased donor pool, decreased wait times for heart transplant, and improved patient outcomes.

Dr. Bethea and colleagues set out to determine whether preemptive, pan-genotypic, direct-acting antiviral treatment could prevent chronic HCV infection in HCV-negative cardiac transplant patients who receive HCV-infected donor hearts.

A total of 25 patients were enrolled. Their status on a cardiac transplantation waitlist was updated to reflect their willingness to accept an HCV-positive donor heart.

If an enrolled patient received an offer of an HCV-positive donor heart as determined by nucleic acid testing, he or she received preemptive treatment with glecaprevir-pibrentasvir.

The first dose of antiviral therapy was administered before transport to the operating room for transplant. After surgery, each patient completed 8 weeks of treatment. HCV viral load monitoring was performed during and after treatment to ensure adequate viral suppression and sustained virologic response (no detectable HCV in the blood for >12 weeks after completion).

At publication, 16 patients had received an HCV-positive donor heart. All have achieved viral suppression with undetectable or nonquantifiable HCV RNA by the ninth day after transplantation. All HCV RNA tests have remained undetectable after initial viral suppression.

No drug-related side effects, interactions leading to lapses or discontinuation of therapy, or treatment failures have occurred. Cardiac allograft and patient survival have been 100% over 1740 cumulative days of follow-up.

Cardiac transplants are limited in the US due to an increasing lack of available donor hearts. While heart failure cases rise rapidly in the US, the number of annual heart transplants has remained the same for the last 10 years.

A significant number of donor hearts are discarded because, though they meet standard criteria for donation, the organs are infected with HCV.

According to Dr. Bethea, approximately 25% of hearts meeting donation criteria in United Network for Organ Sharing region 1 were discarded due to HCV positivity in 2016. All potentially transplantable organs must be identified due to the continued shortage of viable organs. It may be possible to make an underutilized resource available to combat this shortage if direct-acting antiviral therapy effectively prevents chronic infection development in recipients of HCV-positive organs.

Dr. Bethea also noted that the need is critical and time-sensitive to document the efficacy and implementation strategies related to the successful use of HCV-positive organs due to their rising number.

Two pan-genotypic direct-acting antiviral therapies for HCV have been available in the US since 2017:

  • S3/4A protease inhibitor pibrentasvir + the NS5A inhibitor glecaprevir
  • The NS5B polymerase inhibitor sofosbuvir + the NS5A inhibitor velpatasvir + the NS3/4A protease inhibitor voxilaprevir
Pan-genotypic regimens have addressed critical remaining gaps in the capacity to treat challenging populations with HCV infection. 


__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
dharmabum


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Hi Tig and Canuck and all the many new members,

Nowadays, every story told here seems to be a success story. 

 

I must admit that I felt some heart flutters when I read your hurricane story Tig.  Before we knew you were OK.  My mom is a 95 year old Floridian (Palm Beach County) and was supposed to get hit hard.  I was so relieved when the storm changed direction, but sick to my stomach for the west coast/panhandle.

Tig and Canuck, the heart and soul of this forum.  I salute your devotion!!  And I love to read what you've got.  The tone of this forum has become happiness.   In just three years our dreams and wishes have come true.To me it felt like someone turned on the light, handed me a powerful weapon and said go, treat, and heal.  So, I did.

 

Please take good care,

Jo



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Joann

 

Geno 1a  - failed Tx Inc/Int/Rib - Tx Harvoni 1/14/15 - UND at EOT 4/7/15, 7/7/15, 9/9/15, 12/04/15, 10/26/16
Tig


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Hi Joann,

So good to hear from you! Thanks for the article, that’s the kind of positive information I love to see. I’ve wondered about the use of hcv + livers for years and why the choice wasn’t given to the patient, if circumstances were dire already. This is really good news and a blessing to a lot of people, on any transplant list. 



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Canuck


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Here is another one along the same lines (sorta). They are trying to get it down!

 

The three (post-liver-transplant  patients who developed HCV) out of the 25 post-liver transplant  pts., were/are being successfully subsequently treated with  DAA's.

 

 

Published in Gastroenterology

News · October 20, 2017

Hepatitis C Virus-Positive Donor Livers Should Be Considered to Expand the Donor Pool

PracticeUpdate Editorial Team

 

October 20, 2017 - Washington, -  Use of livers from selected hepatitis C-positive donors should be considered because the risk of hepatitis C virus transmission is modest and safe and effective direct-acting antiviral therapies are widely available.

This recommendation, based on results of a prospective cohort study was presented at the 2017 Liver Meeting (American Association for the Study of Liver Diseases), from October 20 - 24.

Khurram Bari, MD, of the University of Cincinnati, Ohio, explained that, given the ongoing shortage of liver grafts for transplantation, the use of increased-risk donor livers (positive for antibodies to hepatitis C virus but with no evidence of active hepatitis C virus infection) may increase the donor pool and get more patients off the waitlist.

Dr. Bari told Elsevier's PracticeUpdate, "Hepatitis C virus-positive donor livers (by antibody testing) with active infection (by serum nucleic acid testing) carry a universal risk of hepatitis C virus transmission and their use is reserved for patients with active hepatitis C virus on a wait list for a transplant."

He continued, "We hypothesized that hepatitis C virus-positive donors without active infection would carry a much lower risk of hepatitis C virus transmission. Livers from such donors may be discarded if a hepatitis C virus-positive patient is not available as a recipient. Our study evaluated the risk of hepatitis C virus transmission from such donors to non-hepatitis C virus-positive patients on transplant waitlists."

Dr. Bari's team studied a group of 25 patients who underwent liver transplantation between 2016 and 2017. These patients did not test positive for hepatitis C virus at the time of transplantation.

The livers they received during transplantation came from donors who tested positive for antibodies to hepatitis C virus and were labeled as hepatitis C virus-positive donors, but tested negative by hepatitis C virus serum nucleic acid testing. This negative result suggested no active infection.

The majority of these donors were determined to be at increased risk of infection transmission by Public Health Service criteria based on donor characteristics.

All organ recipients underwent hepatitis C virus testing 3 months post transplantation. Of the 25 patients in the group, hepatitis C virus transmission occurred in 4 (16%).

Of the 4, one had a prior history of hepatitis C virus/human immunodeficiency virus coinfection and had undergone successful hepatitis C virus treatment 2 years prior to transplantation.

A total of 3 of the 4 recipients were treated with direct-acting antiviral therapy. One recipient completed 12 weeks of treatment and achieved a favorable outcome. The other 2 recipients are undergoing treatment and showed no signs of the virus at weeks 2 and 4. The fourth recipient succumbed to complications brought on by pulmonary hypertension, precluding treatment.

The researchers noted that while all donors were assessed to be at increased risk for transmission according to the Public Health Service criterion, the 16% rate of transmission was much higher than expected for the interval between infection and appearance of mature virus in the serum (eclipse period). 

Dr. Bari said, "Though our study did not look at the specific mode of hepatitis C virus transmission, occult hepatitis C in donors could be one of the possible mechanisms. Our study was the first to estimate risk of hepatitis C virus transmission to non-hepatitis C virus-infected patients using liver grafts from serum hepatitis C virus antibody-positive, nucleic acid test-negative donors."

He continued, "Considering the modest risk of transmission and positive response to direct-acting antiviral treatment, use of such organs could be considered to expand the donor pool."

"Future studies," he added, "should be aimed at determining the exact mechanism of hepatitis C virus transmission from donated organs so that risk of transmission can be further reduced, enabling widespread use of these organs."

 

 



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
Canuck


Guru

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You ALWAYS post such good things! 

How are you BTW?? biggrin C.



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
dharmabum


Senior Member

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Posts: 129
Date:
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Greetings from Connecticut,

We with HCV can  be heart (and kidney) donors!   HCV is now considered a curable disease!  

Here is an informative TIME article:

http://time.com/4996657/heart-transplant-hepatitis-c/

Joann



__________________

Joann

 

Geno 1a  - failed Tx Inc/Int/Rib - Tx Harvoni 1/14/15 - UND at EOT 4/7/15, 7/7/15, 9/9/15, 12/04/15, 10/26/16
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