Research could remove patients from transplant list

Special to Western News

Schulich School of Medicine & Dentistry professor Paul Marotta said by curing the hepatitis C disease, almost one-third of patients on the active liver transplant waiting list can be removed.

By curing the hepatitis C disease, almost one-third of patients on the active liver transplant waiting list can be removed, said a Schulich School of Medicine & Dentistry professor, saving thousands of dollars and opening up positions for those in dire need for a transplant.

Researchers with the Multi-Organ Transplant Program at London Health Sciences Centre (LHSC) and the Lawson Health Research Institute have demonstrated the benefit of treating and curing patients with the hepatitis C virus (HCV) in advanced stages of liver disease.

“For years, severe liver disease from chronic infection with hepatitis C has been the most common indication for liver transplantation, not only in Canada, but also worldwide,” said Dr. Paul Marotta, Medical Director of Liver Transplantation (Multi-Organ Transplant Program) at LHSC. “These impressive results mean not only will this save these patients from the need for transplantation, but will also allow the scarce resource of donor organs to go to others who are in urgent need. This is an incredible outcome.”

HCV is a liver disease spread through blood-to-blood contact. According to the Canadian Liver Foundation, it is estimated 250,000 Canadians are infected with HCV. People with HCV often have no symptoms and many infected people live for up to 20 or 30 years without feeling sick. When, or if, symptoms appear during the late stage of infection, they often reflect serious damage to the liver.

In Marotta’s clinical study, 23 patients with advanced liver disease from HCV, were identified as candidates for liver transplantation. All patients were prescribed oral anti-viral treatment regimens. Of the 13 patients who had completed HCV treatment, nine patients had achieved a cure of their chronic hepatitis C and four more had completed treatment and were pending a result to confirm a cure.

Of the nine cured patients, three (33 per cent) were removed from the liver transplant list due to the vast improvements in their disease severity scores. No significant adverse events were reported.

“HCV therapy that is now available for these patients leads not only to cure in a large percentage, but also to regression of liver disease, suggesting the days of HCV dominating the liver transplant list are numbered,” Marotta said. “These early and impressive results show that we can cure HCV in patients that have advanced liver disease and eliminate the need for liver transplantation. These newer treatment strategies are exceedingly well tolerated, have an excellent safety profile and have high efficacy.”

According to the most recent data from the Canadian Institute for Health Information, hepatitis C was the cause of liver failure for 20 per cent of the liver transplant patients between 2005 and 2014. In 2014, 537 liver transplants were performed in Canada, 27 per cent more than a decade ago.

On Dec. 31, 2014, 507 people were waiting for a liver transplant in Canada. That same year, a total of 119 patients died while waiting for their transplant.

“As an immediate next step, we hope that broadening the sample size across Canada may establish the true impact of this strategy to not only save health-care dollars but, most importantly, to save lives without the need for liver transplantation,” added Marotta, whose research was recently presented at the Canadian Digestive Diseases Week meeting in Montreal.