One reason behind the rise in the availability of livers for transplant over the past 10 years may be surprising: Food and Drug Administration (FDA) approval of drugs to effectively treat hepatitis C.
“If you look back in time before 2011, hepatitis C was one of the main indications for transplantation,” says Phillipe Abreu, MD, PhD, assistant professor of transplant surgery in the University of Colorado Department of Surgery. “There are five different types of hepatitis — A, B, C, D, and E —and B and C are the ones that progress to cirrhosis. In many cases, they progress to cancer in the liver, as well. In 2011, when a new class of medications called DAAs (direct-acting antivirals) was approved by the FDA for the treatment of hepatitis C, it completely changed the treatment of liver disease."
Double benefit
Hepatitis C — a viral infection that causes liver inflammation — is spread through contact with blood and can be transmitted through sexual contact or shared needles among IV drug users. Unlike hepatitis B, there is no vaccine for hepatitis C, but the FDA approval of DAAs for the infection was a game-changer in the transplant world. Not only did the drugs greatly reduce the need for liver transplants in hepatitis C patients; they also made it possible to transplant livers from deceased donors with positive hepatitis C infection to negative recipients.
“For the recipient of an organ from a hepatitis C donor, we simply add one extra medication to the long list of medications they go home with after the operation,” Abreu says. “It’s only for three months, and they get 100% cure to the viral exposure, so using organs from donors with hepatitis — many of whom are younger — is extremely safe.”
Crossing lines
It’s not all good news, however — even as DAAs made available more livers for transplant, rising rates of liver cancer, obesity, and alcohol-related metabolic disease have increased the transplant rates for those conditions as well.
“There is a trend over time of the indications for a liver transplant, and the lines cross in 2014, when hepatitis C starts to drop and cancer and metabolic disease start to rise,” Abreu says. “People are eating worse, so we have more metabolic disease patients, and we have more cancer patients who are becoming transplantable, largely because we have better cancer treatments and more organs available for this population now that we can treat hepatitis.”
Power of modern medicine
Even with the rise in other indications, Abreu says, being able to transplant livers for conditions other than hepatitis C is a testament to the power of modern medical research and development.
“When you have a medication that is good enough to change the course of the treatment of a disease, it’s fantastic,” says Abreu, pointing to similar transformations in perforated ulcer repair after proton pump inhibitors and bariatric surgery after GLP-1analog drugs. “That’s what medicine should do for all diseases."
