HEP-C IN­FECTED LUNGS TREATED AF­TER TRANS­PLANT.

PI­LOT STUDY

Ottawa Citizen - - NP - SH­ERYL UBELACKER

Toronto doc­tors have suc­cess­fully transplanted lungs from de­ceased donors with hepati­tis C into pa­tients in need of the life-sav­ing or­gans, fol­lowed by treat­ment to pre­vent them from be­com­ing in­fected with the po­ten­tially liver-de­stroy­ing virus.

Since Oc­to­ber, sur­geons at Toronto Gen­eral Hos­pi­tal have per­formed the trans­plants in 11 pa­tients as part of a pi­lot study to eval­u­ate the safety of us­ing lungs from hepati­tis C-in­fected donors — a pre­vi­ously untenable idea.

That’s be­cause an­tivi­ral drugs can now cure the disease in 98 per cent of peo­ple in­fected with hepati­tis C, which af­fects an es­ti­mated 250,000 Cana­di­ans, about 40 to 70 per cent of them un­aware they har­bour the blood-borne virus.

“With the opi­oid cri­sis and per­sis­tent high rates of in­tra­venous drug use, we have a great num­ber of po­ten­tial lung donors who are hepati­tis C-pos­i­tive, many of whom didn’t even know they were sick when they were alive,” said Dr. Marcelo Cypel, a tho­racic sur­geon at TGH and prin­ci­pal in­ves­ti­ga­tor of the study.

“The cur­rent pro­to­col is to not use these or­gans, but we started to ques­tion if that still made sense in an era when di­rect an­tivi­ral agents can cure hepati­tis C,” he said.

So last fall, the re­searchers em­barked on the study, with a goal of en­rolling 20 pa­tients in des­per­ate need of a lung trans­plant.

What makes these trans­plants pos­si­ble is the use of a dome-like de­vice known as the ex-vivo lung per­fu­sion, or EVLP, sys­tem de­vel­oped at TGH in 2008. Donor lungs are bathed in a spe­cial so­lu­tion for six hours, al­low­ing doc­tors to eval­u­ate their con­di­tion and as­sess their suit­abil­ity for trans­plant.

Per­fu­sion re­moves about 85 per cent of resid­ual blood in the lungs that car­ries the hep C virus.

Within two to four weeks af­ter the trans­plant, re­cip­i­ents are tested for hepati­tis C and started on a 12-week course of the an­tivi­ral drugs to pre­vent in­fec­tion of the liver, where the virus nat­u­rally takes up res­i­dence. Over time — of­ten decades — in­flam­ma­tion caused by the virus can lead to se­vere cir­rho­sis or liver cancer.

So far, eight trans­plant pa­tients have fin­ished treat­ment for hepati­tis C and are now virus-free; two are still be­ing given the drugs; and one is yet to re­ceive the med­i­ca­tion.

Cypel be­lieves the new pro­to­col will pro­vide “a huge boost in or­gan do­na­tion,” adding roughly 1,000 more donors per year in North Amer­ica, where about 2,600 lung trans­plants are per­formed each year. In Canada, there were more than 240 pa­tients wait­ing for a lung trans­plant in 2016, and about one in five died while on the list be­cause there weren’t enough donor or­gans.

“So I think it’s a big gain and pa­tients will get transplanted sooner as well, as more or­gans be­come avail­able for trans­plan­ta­tion,” Cypel said.

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