- Title: Transplant research aims to salvage infected donated organs
- Date: 11th October 2019
- Summary: TORONTO, ONTARIO, CANADA (MAY 24, 2019) (REUTERS) (MUTE) VARIOUS OF MONITOR SHOWING BREATHING DATA
- Embargoed: 25th October 2019 13:42
- Keywords: infected donor lungs treated and re-used to cut transplant waiting lines lists Toronto General Hospital Marcelo Cypel surgical director University Health Network
- Location: TORONTO, ONTARIO, CANADA / TIJUANA, BAJA CALIFORNIA, MEXICO / UNKOWN LOCATION
- City: TORONTO, ONTARIO, CANADA / TIJUANA, BAJA CALIFORNIA, MEXICO / UNKOWN LOCATION
- Country: Canada
- Topics: Health/Medicine
- Reuters ID: LVA002B0NM1JV
- Aspect Ratio: 16:9
- Story Text: The infected lungs of deceased drug users are being revitalised by doctors in a bid to shrink transplant waiting lines by using the growing number of organs available from drug overdose deaths, many of which are discarded due to stigma.
Drug overdose donors accounted for 13% of donations in the United States in 2018, up from under 4% a decade earlier. They now rank fourth behind donors who died of stroke, blunt injury and cardiovascular problems, but many are not eligible because they're infected with hepatitis C, which is typically spread by sharing needles.
In October 2017, 70-year-old retired subway driver Stanley De Freitas became the first patient to take part in a study at Toronto General Hospital that sought to eradicate the virus from lungs prior to transplant.
A total of 22 patients were tested in the study which was published in The Lancet on Wednesday.
"All of the patients were in a very sick condition waiting for transplant," said Marcelo Cypel, surgical director at University Health Network in Toronto. "Perhaps some of them wouldn't have made it to the transplant time if they were not offered these type of organs."
Only around one in five donor lungs end up being used, but among donors who had hepatitis C in the United States less than 4 percent had lungs used for transplant in 2018, said Cypel.
Yet over 1,400 are in desperate need of a new lung in the United States, according to the U.S. Organ Procurement and Transplantation Network, and hundreds of them die each year while on the list or after quitting because they become too sick for a transplant.
Earlier studies have shown that giving patients antiviral therapy just hours after the transplant surgery can successfully attack the virus before it gains a foothold in the recipient.
Finding ways to overcome the stigma of using such organs and improve their viability could help shrink often years-long waiting times for organs. Researchers are testing different approaches to salvage infected organs like the one De Freitas received.
The Toronto procedure is made possible due to rapid advancements in ex vivo lung perfusion which keeps organs alive outside the body by pumping them with a bloodless oxygenated liquid at normal body temperature, meaning they can be preserved for longer.
This not only enables donors' organs to be transported further and allows surgeons to operate at more suitable times, but crucially gives doctors more time to assess the viability of questionable lungs and rehabilitate them.
"Cold preservation doesn't allow you to do assessment or treatment because the metabolism of the lls are impaired by the cold temperatures," he said.
"The main advantage of machine profusion is the ability to re-assess the function of questionable organs, and also to be able to treat the organ when it's injured."
Most of the lungs used in the study were from young donors who had died of drug overdoses, said Cypel.
The scientists perfused the lungs on a bubble-like machine, made from off-the-shelf components and an ICU ventilator and then added ultraviolet C light irradiation, hoping to deactivate the hepatitis C virus as it was flushed out of the lung and make it non-infectious.
The results of the study were mixed. Although adding light-therapy to perfusion significantly decreased the viral load compared to just using perfusion, all but 2 of the patients contracted the virus. The infected patients, including De Freitas, were treated with a 12-week course of antiviral drugs and the virus was undetectable in all of them after six weeks of treatment. Two patients later relapsed but were retreated and cured of the virus.
Cypel told Reuters further data would be necessary to see whether perfusion plus ultraviolet C therapy would be more beneficial than just giving patients antiviral drugs following transplant. The researchers have completed a not-yet-published further study of their technique in 25 patients where patients were given a shorter-course of antiviral drugs immediately after transplant.
While the perfusion technology is still relatively new, other researchers are examining the possibility of treating organs prior to transplant, particularly as the overall quality of donated organs declines as we get older and fatter.
"It has now been used for liver and kidney transplant as well, and there's also some data more recently in heart transplantation as well. So it's a very evolving field," added Cypel.
But question marks remain around value for money. The use perfusion devices currently is limited by their cost, which can stretch to hundreds of thousands of dollars, and by the lack the expertise and training to use them in hospitals.
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