Written by MJ Franklin, CNN
Waiting lists for transplants are a major source of stress for organ recipients and their families. But new research suggests there may be a more poignant reason why — a raging epidemic of hepatitis C is causing people to risk rejection of the organs they desperately need.
An analysis of data collected in the 19-year COVID-19 epidemic raises concerns that waiting lists could become even longer as the strain of hepatitis C afflicting the country’s liver transplant centers increases.
While the percentage of hepatitis C cases expected to ultimately see the benefits of a liver transplant is small — less than 1% — figures in a recent report suggest the trend could get worse.
With no treatment for hepatitis C, the disease can lead to a crippling liver disease known as fibrosis, which can lead to severe liver disease and death if left untreated.
Although national media coverage in previous years highlighted patients dying as a result of the health threat, it was only in the past six months or so that experts have begun to notice a jump in long-term mortality and morbidity rates among patients suffering liver disease.
According to the latest estimates, national rates of liver disease and death from this disease have doubled over the past six years, from 49% of all deaths from liver disease in 2016 to 78% in 2019.
“The rates in the future are probably going to be around those levels,” said Dr. Youssef Bashir, the study’s author and a senior medical research fellow at King’s College London.
Waiting list increases
The researchers analysed the surgery registries of 29 liver transplant centers around the country between 1992 and 2017, and found that the increase in liver failure after cirrhosis was paralleled by a 12-month increase in cirrhosis patients on waiting lists between COVID-13 and COVID-19.
According to a statement from King’s College London, the increase is in line with a 24% rise in patients requiring liver transplantation as a result of hepatitis C from the year prior to the pandemic to the year after.
The rise is particularly pronounced for patients living in rural areas of England. While the proportion of patients requiring liver transplantation in rural areas grew from 6% to 12% between COVID-13 and COVID-19, the increase in these patients on waiting lists was 45%.
Additionally, more patients seeking transplants died overall than live in areas that received fewer transplants overall during the same period.
“We know that the best way to get the number of transplants is by making sure that there are patients with hepatitis C who can be treated with antiviral medication, and that’s not currently happening,” Bashir said.
The main reason why they believe it will continue to worsen — and eventually result in a much larger number of liver transplant recipients dying from liver failure — is the fact that the number of hepatitis C patients seeking treatment with antiviral medication is decreasing.
The virus was detected in the United States in the 1980s, and for the first decade, the number of new cases was relatively low. It then became the greatest public health threat to the liver until the advent of antiviral medication.
“People began to realize that they could get treated and cured,” said Dr. Paul Gelinas, a professor at New York University Langone Medical Center, who did not take part in the study.
As a result, the number of hepatitis C patients seeking treatment with these new drugs decreased, and between 2011 and 2016, the number of new diagnoses rose by 18%. Since the 2017 introduction of an antiviral medication called new hepatitis C therapies, drug manufacturers have marketed it aggressively and given discounts to acquire more patients.
Although the benefits of treatment remain the same, Gelinas predicts the effects of the virus over the past two decades have been so profound that even relatively healthy patients are now injecting drugs to be able to access this medication.
As the number of cases of hepatitis C increases, Gelinas said, the need for liver transplants to treat recipients will increase too.
The risk of liver disease after liver transplantation is clear, but there is also the fear of transplant rejection, he said.
“The big risk, the next step, is rejection,” he said. “And hepatitis C can produce huge inflammatory responses. If you present with that you will have a rejection, and for transplant you don’t have a lot of time.”
This means liver transplant recipients may be waiting up to five years for the surgery, if transplants occur at all.
To these transplant recipients, Bakar explained, it is a struggle to accept a job that would once have been routine.