New research aims to salvage infected donated organs

 thehindu.com  10/12/2019 17:02:55 

Retired bus driver Stanley De Freitas from Canada 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, Mr. De Freitas said.

After two years, Mr. 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 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.

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. The researchers 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.

Toronto researchers used a solution from Swedens Xvivo Perfusion AB with the hospitals 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.

Infected patients, including Mr. 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 re-treated and cured. One patient in the study died due to complications from lung transplantation.

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 study. Perhaps some of them wouldnt have made it to the transplant in time if they were not offered these type of organs.

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