New Treatments for Hepatitis-C Open New Possibilities for People Waiting for Kidney Transplant
Patients with Hepatitis C Can Safely Receive Kidneys from Hepatitis C-Positive Donors, then be Cured of the Virus
September 18, 2018
(Washington, D.C) Elliott Stevens of Maryland has a new kidney and is cured of hepatitis C after a transplant and treatment at the MedStar Georgetown Transplant Institute that includes the use of newly approved anti-viral medications.
Stevens, 60 was diagnosed with end-stage kidney disease in 2015. He needed a transplant as soon as possible. But because of his blood type and a national waiting list of nearly 100,000 patients, he was told his wait could be seven to eight years. In addition to having kidney disease, Stevens contracted hepatitis C after a blood transfusion he received as a child.
“I had to go on dialysis right away. I know it saved my life but dialysis really tore down my body,” recalls Stevens, recently retired after 28 years at FedEx. “I was hooked to a machine for four hours a day, three days a week and afterwards all I could do was crawl back into bed to rest. I missed my wife and two daughters and could no longer travel.”
But in March of 2017 Stevens got a call from MedStar Georgetown. A kidney was available. The catch was that the kidney was from a hepatitis C – positive donor.
“For more than a decade we have been using kidneys from hepatitis C-positive donors for some recipients already infected with the virus,” says MGTI Transplant Nephrologist Alexander Gilbert, M.D. “We can safely give hepatitis C-positive kidneys to patients who already have hepatitis C because in that case there is minimal risk of transmitting the disease since the patient has already been exposed. Once we get the kidney into the recipient, we can then go back and treat the recipient and cure the hepatitis C. The newest advance in this process is better, more effective treatments for hepatitis C.”
And that’s just what happened in the case of Elliott Stevens.
“I have some family members who have high blood pressure and other health problems that mean they couldn’t be a living donor for me,” says Stevens. “I was weighing that seven year waiting list in front of me and being on dialysis and I looked at my wife and daughters and said, ‘yes I want to take a chance on this and spend more time with them,’” says Stevens. “I didn’t want to wait seven years getting to a critical state medically where I might not be able to survive a kidney transplant.”
“This is exciting because in Mr. Stevens’ case we were able to shorten his wait time from seven or eight years, to barely 400 days, and then cure him of his hepatitis C,” says Matthew Cooper, M.D., director of Kidney and Pancreas Transplantation at the MGTI.
Estel Swayne, 60 of Maryland had a similar experience. After living with diabetes since 1997 she found out in 2015 that she had contracted hepatitis C.
“While I was waiting for a kidney transplant, I was on dialysis,” recalls Swayne. “I was so absolutely exhausted all the time. I just went to dialysis and all I wanted was my bed.”
“We know that dialysis is not a comfortable or easy way to live. Studies show that patients live significantly longer with a kidney transplant versus dialysis,” says Dr. Cooper.
After a few months on the list for a kidney at MedStar Georgetown, Swayne received a kidney from a deceased donor who was hepatitis C-positive.
“I already had hepatitis C, so it wasn’t going to make a difference to me,” says Swayne. “It’s not like they could give me something I didn’t already have. I knew I couldn’t stay on dialysis too long or other things should start happening to me and I might not be a transplant candidate.”
“What’s made this possible is the advent of new anti-viral medications approved in 2015 that we expect to permanently cure a patient of their hepatitis C more than 95% of the time, with few side effects and only a short course of treatment, about 12 weeks,” says Dr. Gilbert. “The old hepatitis C medications only worked 60% of the time, came with serious side effects and had to be taken for six months or longer.”
“The last time I came for my checkup, there was no sign of hepatitis in my body,” says Stevens. “I consider this a win-win. I no longer have kidney disease and I am cured of hepatitis C. I am so grateful and I feel wonderful. I am back to taking walks with my wife, spending more time with my daughters and I’m back to volunteering in my church. I could not be happier.”
After her transplant in September 2016 and a course of the new hepatitis C medication, Swayne’s blood work confirmed that she is free of the hepatitis C virus.
“I feel great. I actually have the energy to do things,” says Swayne. “I like to fish and hike and spend hours and hours in my garden. I hadn’t been able to do these things in quite some time. I go all over the place now.”
“Our next step is to transplant hepatitis C-infected kidneys into carefully selected patients who need a kidney but do not have hepatitis C and then treat them for hepatitis C after transplant,” says Matthew Cooper, MD, “Our goal is to get them off the long waiting list and return them to their lives.”
The MGTI plans to increase the availability of kidneys from hepatitis C-positive donors through future studies.
A recent study of 20 patients without hepatitis C, who received hepatitis C-positive kidneys, found that all were free of the disease after transplant and treatment.
“This could be a game changer,” says Dr. Gilbert. “This wouldn’t be for everyone but could be ideal for patients who don’t do well on dialysis and who face longer wait times. Their only choice for a new kidney might be to receive a kidney from a hepatitis C-positive donor, then get treatment for hepatitis C after transplant.”
“I hope I can encourage others with my successful outcome along the way,” says Stevens. “I just feel so grateful to my donor and to my Georgetown transplant team, that I hope I can give back what someone has given me, which is a second chance at life.”
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