New Source of Organs Offers Hope for Liver Transplant Patients
John Wiessner’s illness began with nonalcoholic fatty liver disease. “And then it turned into cirrhosis and then it turned into being worn out,” he says.
“That’s really a kick to the head when somebody tells if you don’t get a liver, you’re going to die.”
After nearly two years on a transplant list, Wiessner, 64, got his new liver in June 2018 because of an Einstein program that greatly expanded the options for a potential donor. But he had to accept an unusual condition: the new liver most likely would give him a serious infection, hepatitis C.
Chronic hepatitis C is a leading cause of cirrhosis, which is one of the most common reasons that people need a liver transplant. But Einstein now offers liver transplants from donors who test positive for hepatitis C to patients who don’t have the infection because new treatments have made it at least 95% curable.
The program increases the chances of receiving a new liver — and a new chance at life — for someone who might otherwise have died on a waiting list.
Yet Wiessner, of Westmont, N.J., hesitated at first. “I was ready to die. You know, I gave up hope.”
Strong Early Results
Einstein began the program in January 2018, encouraged by the early results at a few major medical centers in the country, says Victor Navarro, MD, Co-Chair of Einstein’s Department of Digestive Disease and Transplantation.
Currently, Einstein is the only Philadelphia hospital doing hepatitis C-positive liver transplants on uninfected patients, says Tracy Drufovka, Service Line Administrator for the Department of Digestive Disease and Transplantation. Hahnemann University Hospital, now closed, had done a few such transplants, she says.
The program has been so successful that it recently expanded to kidney transplants, with one patient receiving a transplant so far.
In the past, when an organ donor tested positive for the hepatitis C virus, the organs would be given only to patients who already had the infection, Dr. Navarro says.
But beginning in 2013, the FDA approved a succession of new drugs and drug combinations that transformed hepatitis C treatment. “We went from a 40% cure rate up to a 95%-plus cure rate,” Dr. Navarro says.
Treatment after the transplant involves taking only one pill a day for eight to 12 weeks, and there are few side effects.
Wiessner wasn’t worried about getting hepatitis C, though. “I was more worried about getting the liver from a heroin addict, that I would wind up like the babies are when the mother is an addict.”
That’s a common myth, but it doesn’t happen, says Liver Transplant Program Manager Donna McGill.
Within a couple of weeks, Wiessner changed his mind. “He was outvoted,” says his wife, Joyce. Wiessner’s mother, Joyce, and their two sons all urged him to accept the offer.
The Wiessners like horse racing, so Joyce looked at the odds. “If you had to wait until the ideal liver and your numbers matched, the blood group matched and all that matching…,” she says. “This puts you in a better position to get a liver.
“I said, ‘You know, you’re getting weaker and weaker. There’s things we still want to do. And he said, ‘OK, where do I sign?’”
Infection, Then a Cure
Of the 33 patients transplanted so far by Einstein, 14 became infected with hepatitis C, were treated successfully, and have no virus in their bodies, says McGill. Nine are still receiving treatment or recently finished, and four have not started treatment.
Six other patients never developed hepatitis C, she says. Their organ donors did not have active hepatitis C infection, although antibodies in the donors’ blood indicated that they had it in the past.
“These organs are often excellent.”
— Tracy Drufovka
National results so far suggest that people who receive livers from hepatitis C-positive donors do just as well as other patients. A 2019 study in the journal Hepatology found that 87 livers from donors with active hepatitis C had been transplanted into people who did not have the disease. Two years after transplant, patient survival without rejection of the organ was similar to that of people who received uninfected livers.
Transplant surgeon Radi Zaki, MD, Co-chair of Einstein’s Department of Digestive Disease and Transplantation, says Einstein started the program to match organs that were being discarded with patients who needed them. Dr. Zaki performs nearly all of the hepatitis C-positive liver transplants, assisted by his team of transplant surgeons.
As hepatitis C treatment has improved, the number of liver transplant patients who have active infection has decreased, Dr. Zaki says.
“Then you had the expansion of the number of donors that died of drug overdoses, and a large majority of them have hep C,” he says. “But the organs are getting discarded. They’re not being used, and you can be using them.”
Drufovka noted that many people with hepatitis C who die of an overdose or homicide that permit transplant of the organs are young and basically healthy, so “these organs are often excellent.”
Special Consent Form
People who want to be considered for a hepatitis C-positive liver must sign a special consent form, Dr. Navarro notes.
“Not only do they have to be educated about hepatitis C and the risks and benefits and alternatives, they also have to realize that they’re accepting a new infection. And they actually have to recite back to us that they understand the risks.”
At first, the hepatitis C-positive livers were offered only to people who were very sick but unlikely to meet the criteria for receiving a liver soon.
Many factors go into the process of matching donor livers with patients, but one of the most important is the MELD (Model for End-stage Liver Disease) score. The score, which ranges from 6 to 40, is based on laboratory test results.
“This liver’s been treating me good. I feel great.”
— John Wiessner
For some patients, Dr. Navarro says, “their illness does not seem like it’s accurately reflected in their MELD score.” These are some of the patients who were initially asked if they would consider a hepatitis C-positive liver.
Results have been so good that hepatitis C-positive transplants are now offered to anyone on the transplant list. “If I needed a liver transplant and my score wasn’t qualifying me to get a transplant,” Dr. Zaki says, “I would definitely take one for myself.”
Wiessner thinks he wouldn’t have lasted much longer without the new liver. He cried when he first saw it on an ultrasound. “It’s amazing,” he says. “It looked like mine but cleaned up, like it went through the car wash.”
Wiessner says the hepatitis C virus appeared in his blood just a couple of days after surgery. It disappeared halfway through his eight weeks of treatment with Mavyret (plecaprevir-pibrentas), which cured the infection.
Because he had been so weak before the transplant, “it took 13 months to really feel like myself,” he says. “But this liver’s been treating me good. I feel great.”
Learn more about Einstein organ transplant services.
Photo: Joyce and John Wiessner with Liver Transplant Program Manager Donna McGill