The transplant team at the University Hospital of Wales in Cardiff have successfully transplanted kidneys from donors infected with Hepatitis C.
The procedure was the first of its kind in the United Kingdom and represents a medical breakthrough in both organ transplantation and the treatment of Hepatitis C.
Hepatitis C is treated using direct acting antiviral (DAA) tablets. DAA tablets are the safest and most effective medicines for treating Hepatitis C.
In Wales, DAA tablets have been available on the NHS to treat and cure all cases of Hepatitis C since 2014.
With an estimated 12,000 people affected by Hepatitis C in Wales, it is this availability of treatment which is allowing them to now become organ donors whereas they would not have been previously considered.
Advances in the medicine used for the treatment of Hepatitis C means that those with the virus can now be cured entirely over the course of just 12 weeks. There is a less than a 1-in-2500 chance that the disease would not be cured.
With the knowledge of the ability to cure Hepatitis C and evidence to support the treatment’s efficacy, in 2018, the British Viral Hepatitis Group chaired by Dr Ahmed Elsharkawy issued a UK position statement on the use of Hepatitis C positive donors in Hepatitis C negative recipients.
As Cardiff and Vale UHB’s transplant unit met all criteria to implement this change in policy facilitated by availability of DAA, in the summer of 2018, staff from the transplant team worked with the Blood Borne Virus team and Welsh Specialist Virology Centre Cardiff (Public Health Wales) in concert with partners in NHS Blood and Transplant, Welsh Government and the British Viral Hepatitis Group to implement a transplantation process from donors with Hepatitis C to recipients without the virus.
Developing and then implementing the programme has taken time and careful consideration. Dr Sarah Browne consultant transplant nephrologist has led the process in Cardiff in collaboration with patient representatives as well as local experts in treating and diagnosing Hepatitis C.
Sarah Browne, a Nephrology Transplant Consultant from Cardiff and Vale, who has championed this project since its beginning, said: “We are thrilled that the work we have been doing at the University Hospital of Wales to champion the safe transplantation of kidneys from donors with Hepatitis C is beginning to come to fruition.
“Thanks to the availability of DAA across NHS Wales, we have been able to allow many more people to become kidney donors and improve the lives of those patients waiting to receive a kidney.”
Patients in need of a kidney transplant face an uncertain future, and there remains a shortage of organ donors despite innovations such as the Welsh opt out system. For some patients their health will deteriorate before a suitable organ is identified, and on average three die every day in the UK because of the shortage of organs. Any new treatment that increases the number of available organs therefore is of great importance, and demonstrating that organs can be safely transplanted from donors with Hepatitis C is important not just for Welsh patients but also for those across the whole United Kingdom.
Potential kidney donors are screened extremely carefully and aspects of both their medical and social history are considered during the process of deciding whether to accept their organs, as is the case with any potential organ donor.
All patients joining the transplant list in Cardiff are now offered the extra option to consider organs from donors with Hepatitis C and are counselled of the small additional risk associated with this. It is an individual decision whether or not to consider this new type of donor, and any patient who does not want to accept the risks will only be offered kidneys from donors who do not have Hepatitis C. However, for many patients on a waiting list, it is a risk which they are willing to take as it represents a new option to receive a good quality kidney often much more quickly than they would have otherwise. this year, Mr Doruk Elker, Consultant Transplant Surgeon at the University Hospital of Wales, performed the first ever transplantation in the UK of kidneys from a donor with Hepatitis C to two recipients who did not carry the virus.
The two recipients, Phillip Gillespie and Lorraine Carpenter, were then followed carefully with regular testing carried out at the Welsh Specialist Virology Centre Cardiff. The patients were treated as soon as the virus became detectable following advice from the Blood Borne Virus team Cardiff and Vale with specialist input from Rhys Oakley Specialist Pharmacist in Hepatitis. Both have made a full recovery. Surgeons at UHW have performed a further 4 transplants from 3 further donors with Hepatitis C.
Mr Gillespie said: “Having been invited to take part in the Hep C trial, I found the information I was given very helpful. I felt that it was a no brainer to accept a Hep C Kidney, as I would possibly get a younger kidney and hopefully receive one a lot sooner than I would on the general waiting list. I was on dialysis for around 17 months and it was a struggle dialysing 3 times a week. I could feel my health deteriorating and I was concerned that if I waited for a kidney from the general transplant list that I wouldn’t be in good enough health to be accepted for the transplant.
“All of the transplant team at UHW were so invested in my well-being and I found the transplant and recovery was exactly as had been explained to me during my pre-operation discussions. I feel that the other patients at the transplant clinic, the staff, and I are part of a new transplant ‘family’; something which I find very supportive.
“I am recovering well, although the Hep C medication sometimes leaves me fatigued. However, I can put up with this as I no longer have to go to dialysis 3 times a week. Having the transplant changed my life for good and every day I feel better than I did the day before; now I will be able to spend more quality time with my grandchildren. I remind myself every day that someone else’s tragedy has given me this new lease of life and I say thank you most days to my donor.”
Mrs Carpenter said: “From the start of me having kidney problems some six years ago to today, I have had nothing but excellent treatment from the team here. Before having a kidney transplant, I was dialysing every night for about seven months. I’m a positive person so I didn’t let it affect me too much but I did find it difficult to plan to do things.
“When the team asked me if I would consider a kidney with Hepatitis C, I didn’t hesitate: I jumped at the chance. They explained everything to me so clearly that I felt as though I had nothing to lose and wasn’t at all frightened.
“My niece was actually a potential live donor lined up for me but I was much happier to accept this kidney to save her from having to have the operation. However, following my transplant I felt so sad for my poor donor. Saying thank you isn’t enough because what they have given me is simply my freedom.
“Since the operation, my treatment to cure my Hepatitis C has been good and I expect to be totally cleared of it really soon. Today, I’m feeling tremendous and very humbled to be the one of the first recipients of this type of kidney and am constantly in awe of how many more lives can be saved.”
Dr Ahmed Elsharkawy, chair of the British Viral Hepatitis Group, said: “In using DAAs, over the last few years it has become clear that these drugs are extremely effective at treating and curing people of Hepatitis C. At the same time, as a transplant physician, I was more than aware of the fact that organs from Hepatitis C-positive donors were not being used at a time when potential transplant recipients were suffering and sometimes dying while on waiting lists.
“Clinical practice elsewhere in the world is currently showing that accepting kidneys from donors with Hepatitis C and treating recipients with DAAs is safe and effective.
“I was therefore keen to see this practice begin to take place in the UK in order to enable us to utilise what are otherwise good organs in order to save people’s lives.”
Health Minister Vaughan Gething, said: “I am delighted to see the team at University Hospital of Wales, Cardiff are leading the way in the UK with this pioneering transplantation. The availability of DAA tablets on the NHS in Wales is not only helping treat Hepatitis C but allowing more people to become organ donors, which can help save more lives.”