New transplant research aims to salvage infected donated organs

Retired subway and bus driver Stanley De Freitas had just celebrated his 70th birthday when he started coughing, tiring easily and feeling short of breath. He was diagnosed with pulmonary fibrosis, a severe scarring of the lungs, and put on the wait list for a transplant.

“Life became unbearable. From the time I got up in the morning until when I went to bed at night, I struggled through every breath of air,” De Freitas, now 74, told Reuters by phone from his home in Toronto.

After two years, De Freitas was offered a lung, with one significant downside: The donor had hepatitis C.

In October 2017, he became the first patient enrolled in a just published study conducted at Toronto General Hospital testing a technique that aimed to flush out and inactivate the hepatitis C virus from donor lungs before a transplant.

The research comes amid a spike in available organs linked to the opioid overdose crisis, meaning many are contaminated by hepatitis C as the virus is commonly spread by sharing needles. Since it can easily infect an organ recipient, those organs are usually discarded despite the urgent need. 

Data from the United Network for Organ Sharing (UNOS), which matches donors with recipients, shows that 97 percent of people waiting for a lung in the United States last year were unwilling to accept an organ from a donor who tested positive for hepatitis C.
 

While hepatitis C causes serious liver disease, the virus can be present in the blood in other organs.

Researchers are testing different approaches to salvage infected organs.

A study published in April showed that giving patients antiviral therapy just hours after transplant surgery can successfully attack the virus before it gains a foothold in the recipient.

Eliminating the virus prior to transplant would simplify the procedure for patients, said UNOS Chief Medical Officer David Klassen. It could also significantly cut down on wasted donor organs. 

The technique used in Toronto, known as ex vivo lung perfusion, keeps organs “alive” outside the body by pumping them with a bloodless oxygenated liquid. They used ultraviolet C light to irradiate the solution, aiming to deactivate the hepatitis C virus and make it non-infectious.

Perfusion allows doctors to evaluate and potentially rehabilitate organs for transplant, and buys them more time than storage in ice boxes, which can cause tissue damage.

Toronto researchers used a solution from Sweden’s Xvivo Perfusion AB with the hospital’s own ex vivo lung perfusion system, a bubble-like machine made from off-the-shelf components and an intensive care ventilator.

The study of 22 patients, published in The Lancet Respiratory Medicine on Wednesday, had mixed results. Adding light therapy significantly decreased the amount of virus, but all but two of the patients contracted hepatitis C, which is now curable.