These kidneys see less stigma
More infected with hepatitis B are being used in transplants
John Pollard has been living with a transplanted kidney since June 2019.
His old kidney, worn out by high blood pressure, was working at 10%, and he was on dialysis.
What was different about Pollard’s transplant, compared with most of the record 24,669 kidney transplants performed in the United States last year, is that his donor had hepatitis B.
Pollard, 65, who lives in Groton, said he “had high blood pressure since … probably in myteens, but it wasn’t diagnosed. One of those genetic freaks, I wasalways pretty healthy until I was 60.”
A continual need for organ donations, combined with the opioid epidemic that is helping spread hepatitis Bandotherinfections, have made using kidneys that are positive for hepatitis B a more appealing option for transplant surgeons, such as Dr. Glyn Morgan, chief of transplant surgery at Hartford Hospital.
“This is an area where a lot of transplant centers around the country are still struggling with, but we’ve been using them for several years very safely,” Morgan said. Using organs that are positive for hepatitis B allows for “the utilizing of these organs from donors that might be discarded or set aside.”
There is a risk, but it’s small, Morgan said. “The risk is, could you transmit the hepatitis B virus to the recipient during surgery?” hesaid. Yes, it’s possible, but many, such as Pollard, have been vaccinated against hepatitis B because they’re ondialysis, and those who get the disease can be treated easily with common drugs.
Pollard learned about getting on the transplant list while he was on dialysis for two years. “You just kind of educate yourself, why you’re in there, why you’re going through it,” he said. He learned he could register to get on the transplant list maintained by the United Network for Organ Sharing. Both Hartford Hospital and Yale New
Haven Hospital transplant organs positive for hepatitis B.
When he was offered a positive kidney, “I kind of hesitated, but you know it was explained to me that you had the shot so you won’t contract it. So I said, what the heck. I wouldn’t recommend being on dialysis to anybody.”
Dialysis, which requires hours-long sessions three times a week, can be a source of infection, which is why patients are vaccinated against hepatitis B and other diseases. Pollard did not become positive for hepatitis, he said.
“Everything went smoothly,” he said. “It’s anunbelievable experience considering what you go through.” In fact, the surgery went more smoothly than most.
“Usually when you get a kidney it takes sometimes a few days to be able to urinate and get it going,” Pollard said. “I was peeing allo ver the operating table.”
Afterward, “all you’ve got to do is take your meds and drink a lot of water like they tell you,” he said. Now his blood pressure always comes back normal. The kidney is “working properly instead of struggling,” he said. “The kidneys and the heart, they work together.”
Dr. Faiqa Cheema, medical director for infection prevention and epidemiology at Hartford Healthcare, recently published a paper in the journal Transplant Infectious Diseases describing giving hepatitis B-positive kidneys to eight patients.
“Thenumberof[end-stage kidney disease] patients awaiting [kidney transplantation] far exceeds the number of organ donations globally and leads to a problem of organ shortage ,” she wrote.
“Wedidthis project basically because dialysis patients have an increased risk of death and morbidity while they’ re hooked up to the machine,” Cheema said. “The longer you are on dialysis and connected to the machines, it can shorten your life by up to 10 years.”
Patients are vulnerable to infections, heart disease, electrolyte imbalances and arrhythmia, she said.
“Ourstudylooksat taking donors that have passed away that may have been infected with acute hepatitis B,” she said. “It’s one of the solutions that we have to overcome this challenge of a shortage of organ donation.”
Cheema said patients were chosen who were immunized against hepatitis B because therisks haven’t been“studied longterm.” Out of eight patients, two later developed antibodies in their blood, called seroconversion. “They did not have any evidence of the virus replicating because the antiviral stopped it, and it did not have any impact on their kidney function long term,” she said.
“The reason why we can do this is because we live in an era where we have strong and effective hepatitis Bvaccines andreally effective treatments or antiviral therapies.”
Using infected kidneys is important because people in need “would otherwise be waiting a long time or [would] die while waiting on the list.” Morehepatitis B-positive kidneys are available because “sadly, we have an opioid crisis,” Cheemasaid, andthedisease is spread through intravenous drug use and sexual transmission.
“Most of these organs are from young kids who unfortunately pass away from drug overdoses, but they have really healthy organs ,” she said. While some patients are reluctant, “at Hartford Healthcare we participate in a lot of patient education on removing stigma,” she said.
Morgan said in order for a patient to receive a kidney from a hepatitis B-positive donor, “they have to have what we would consider the protective level of antibodies in their system,” either through vaccination or from having had hepatitis Bthemselves.
The antiviral medications used to treat any cases of hepatitis “are highly effective,” Morgan said. “You give them the therapy and the therapy is 98 to 99% effective.”
At Hartford Hospital, “We routinely, for any patient that we put in this program, we say, yes, we would be interested in accepting or entertaining organs of hepatitis B-positive donors,” Morgan said. He said when he looks at some other transplant centers, “the list of people eligible or declared interest is very muchsmaller.”
He said the program has been a success .“so far, so good. Everyone has done well,” he said. “We’ve had no evidence of hepatitis B infections in any of these patients, and they’ re doing well with their kidneys.”