Can Effective New Drugs Make Organs from HCV-Infected Patients Viable for Transplants?

With significantly long wait times for a kidney transplant, researchers have begun to explore never before considered alternatives for people without much time to spare.

A study by the Perelman School of Medicine at the University of Pennsylvania and published in The New England Journal of Medicine noted that the average wait time for a kidney transplant is 5 years, with more than 100,000 people currently on the waiting list. Yet thousands of viable kidneys are discarded each year due to hepatitis C virus (HCV) infection, the study noted.

In light of highly effective new drugs like Sovaldi and Viekira Pak with cure rates in excess of 90%, stakeholders should begin to explore using HCV-infected organs in transplant candidates with or without pre-existing HCV infection, according to the study.

The researchers noted that this process, which will intentionally infect patients with HCV via transplant, will require significant oversight and consideration. The benefit for patients who may otherwise not receive a kidney transplant should far outweigh the concerns, according to the authors.

“The resulting expansion of the donor pool could save hundreds of lives each year,” the study authors wrote.

The researchers hypothesize that HCV-positive kidneys can be offered to uninfected patients with a high risk of health deterioration should they continue dialysis. These uninfected patients include the elderly and people with serious comorbidities, such as cardiovascular disease, disadvantageous blood types or other conditions that would lead to a years-long wait time for an appropriate uninfected kidney to become available.

For this to become a viable option, the researchers stated that a rigorous informed consent process that outlines the risks, significant involvement by institutional review boards, and multicenter trials are necessary. It was also noted that the costs of transplanting HCV-infected kidneys into uninfected recipients would be high, however, this could be offset by a reduced cost for dialysis time in people who would otherwise have a longer wait time for a transplant.

The authors wrote that "providing HCV-positive kidneys and HCV therapy to HCV-negative recipients will lead to better outcomes than dialysis."