Breakthrough hepatitis C treatment helps those in need of organ transplants
Brad Goodman knew he likely had a long wait for a new liver. For the past six years, the 36-year-old father of three was in and out of the hospital, fighting off bile duct infections caused by primary sclerosing cholangitis (PSC), a chronic, progressive liver disease. Those hospitalizations became longer and more frequent as the disease advanced. But hope came in the form of an unusual question from his UChicago Medicine team: would you accept a liver if it was positive for hepatitis C?
“The only thing I knew about hepatitis C was that people get liver transplants because they had it,” Goodman said. “Once I was educated about it, there was no hesitation, not at all.”
Hepatitis C is a viral disease afflicting an estimated 71 million people worldwide. Formerly, the infection was considered difficult to treat, requiring a year-long drug regimen that only cured about half of patients. But starting in 2011, a new class of antiviral medications dramatically improved outcomes, raising cure rates to nearly 100 percent.
Starting in 2011, a new class of antiviral medications dramatically improved hepatitis C outcomes, raising cure rates to nearly 100 percent.
Now, the progress in treating hepatitis is creating unexpected ripple effects in the world of organ transplants. Organs from hepatitis-positive donors were typically rejected by most transplant teams in all but the most desperate of cases, due to concerns over the infection causing post-transplant organ loss. But a select few centers, including the University of Chicago, have reconsidered that philosophy in light of the new hepatitis drugs.
“Hepatitis C is the easiest thing we treat these days. We can cure almost everyone,” said Michael Charlton, professor of medicine, director of the Center for Liver Diseases, and co-director of the Transplantation Institute. “So if we take livers that are really healthy from young, heroic donors who had hepatitis C and offer those to patients who have these life-threatening or quality of life-altering conditions, they can get a transplant much sooner.”
Currently, the University of Chicago Digestive Diseases Center is the only center in the city that takes hepatitis-positive livers. That distinction allowed Goodman to receive an organ that probably would have gone to someone much higher on the transplant list, Charlton said.
The key factor is educating patients about the virus and the significant strides made in treatment, said Sonali Paul, assistant professor of medicine. Paul recently surveyed patients on the kidney transplant list about their willingness to take hepatitis-positive organs, and found that acceptance increased with more information.
Patients on the kidney transplant list were surveyed about their willingness to take hepatitis-positive organs. Their acceptance increased with more information about treatment.
“Hepatitis C is one of those viruses that’s very stigmatized and has been for so long, so I think patients really need to know what the virus is and how treatable it is,” Paul said.
Goodman said he appreciated the frankness and honesty with which Charlton and his other physicians — including David T. Rubin and surgeons Talia Baker and Adam Bodzin — presented him with the choice. As he looks forward to a very meaningful first holiday season post-transplant with his family, he expressed his deep gratitude for the team presenting him with this little-known option.
“It’s one of those things where if I wasn’t willing to take somewhat of an unorthodox route, I wouldn’t have gotten an organ,” Goodman said. “These people literally saved my life. I’ll feel indebted until the day that I naturally die from something that’s not liver disease, to what they’ve done for us. Because they’ve repaired a family. It’s just jaw-dropping.”
This story was originally published by the Gastro-Intestinal Research Foundation. Photos by Beth Rooney.
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