MedicalResearch.com Interview with:
Jagpreet Chhatwal, PhD
Assistant Professor, Harvard Medical School
MGH Institute for Technology Assessment
Boston, MA and
Sumeyye Samur PhD
MGH-Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: The number of patients who are in need of liver transplant continues to rise whereas the availability of organs remains limited, therefore, it becomes is important to utilize all available livers.
Under the current practices, only Hep-C infected patients are eligible to receive infected livers. However, with the advent of high efficacy drugs, number of infected recipients has decreased over the last decade. On the other hand, with the rise of opioid use, number of Hep-C infected organs increased. With this contradiction, it becomes paramount of importance to utilize the infected livers which could help save more lives on the transplant waiting list.
MedicalResearch.com: What is your approach?
Response: The ideal solution would be to conduct a randomized controlled trial to evaluate the trade-offs of this approach. However, such a trial would be prohibitively large and time consuming. In such cases, mathematical modeling is very useful to inform clinical-decision making. Therefore, we developed a model and conducted a virtual trial to determine the uninfected patients who could benefit most from accepting Hep-C infected livers.
MedicalResearch.com: What are the main findings?
Response: Our study shows that transplanting Hepatitis C livers into non-infected patients can decrease the waiting time and mortality in the waiting list. Those who receive infected livers can be treated with the high-efficacy Hep-C drugs and cured following the transplant. Though there are risks of receiving an infected liver, the benefits outweigh the risks especially in the patients with advanced disease.
MedicalResearch.com: What should readers take away from your report?
Response: The benefit of accepting an HCV-positive liver outweighs the risks in the majority of patients on the transplant waiting list. The magnitude of the benefits depended on the severity of a patient’s liver disease and in regions hard hit by the opioid epidemic, such as the Northeast, that have greater numbers of HCV-positive donors
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Patients who receive an infected liver should be given Hep-C therapy following the transplant. However, treatment is expensive and the value of such approach is not known. Therefore, it is necessary to evaluate the cost-effectiveness of transplanting infected livers to uninfected patients, which would be useful information for payers.
MedicalResearch.com: Is there anything else you would like to add?
Response: Transplanting HCV-positive livers into HCV-negative patients followed by a Hep-C treatment could be a life-saving option for many patients on the transplant waiting list especially in the regions with high HCV-positive donor organ rates.
In addition, while the opioid epidemic has led to the increased availability of HCV-positive organs of all types, the trend should not be seen as beneficial. The opioid epidemic is a major health crisis affecting communities across the country, and we want to reiterate our support for efforts to address the growing epidemic.
This study was supported by the American Cancer Society Research Scholar Grant RSG-17-022-01-CPPB, Health Resources and Services Administration contract 234-2005-37011C, National Institutes of Health grant DK078772, National Science Foundation award 1722665, and the MGH Research Scholars Program.
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Transplanting HCV-positive livers into HCV-negative patients with preemptive antiviral treatment: A modeling study.
Chhatwal J1,2,3, Samur S1,2, Bethea ED1,2,3, Ayer T4, Kanwal F5,6, Hur C1,2,3, Roberts MS7,8, Terrault N9, Chung RT
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