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 "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 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.
Infected patients, including De Freitas, were treated with a 12-week
course of antiviral drugs that rendered the virus undetectable in
all of them. Two of those patients relapsed but were retreated and
cured. One patient in the study died due to complications from lung
transplantation.
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“All of the patients were in a very sick condition," said Marcelo
Cypel, surgical director at University Health Network in Toronto and
co-author of The Lancet study. "Perhaps some of them wouldn't have
made it to the transplant in time if they were not offered these
type of organs."
The researchers are planning another study combining perfusion with
a photodynamic therapy, a type of light they believe could be more
effective against the virus than ultraviolet because it can
penetrate the organ as well as the solution.
OUT OF TRAGEDY, A GIFT
In the United States alone, almost 113,000 people are on organ
transplant lists, including more than 1,400 awaiting a new lung.
Hundreds die each year while on the list or after becoming too sick
to endure a transplant.
A tragic public health crisis has led to an unexpected opportunity.
With the jump in deaths from opioids such as heroin and fentanyl,
overdose victims now account for 13% of U.S. organ donations, up
from less than 4% a decade ago, according to UNOS.
Many of those organs are going to waste. For example, last year less
than 4% of hepatitis C positive donors in the United States had
lungs used for transplantation, the study's authors said in the
paper.
Other researchers are working with perfusion technology to improve
the function of donated lungs, hearts and livers.
Scientists at the University of Oxford were able to improve the
quality of 16 donated livers with signs of a fatty liver disease.
They treated donated organs outside the body with drugs and captured
fat that was washed out of the liver through a filter on a
transportable perfusion device developed by Britain-based OrganOx,
according to a study presented last year.
OrganOx has European Union clearance to use its device on livers and
hopes to gain U.S. approval by the end of 2020.
Perfusion device use currently is limited by cost, which can stretch
to hundreds of thousands of dollars, and by lack of expertise and
training.
De Freitas, though, is grateful the Toronto researchers are testing
perfusion to salvage organs.
“Every day I get up and I thank the Lord, I thank the doctors
because I am not supposed to be here," he said. "I am supposed to be
on the other side.”
For a graphic on U.S. organ donors by mechanism of death:
https://fingfx.thomsonreuters.com/
gfx/editorcharts/HEALTH-ORGANS-TRANSPLANTS/
0H001PGB86JE/index.html
(Reporting by Caroline Copley in Berlin and Canice Leung in Toronto;
Editing by Elyse Tanouye and Bill Berkrot)
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