Jul 31, 2014 — It’s a bit of a dilemma: you can’t treat a patient’s Hepatitis C because they have kidney failure, and their kidney failure is only going to get worse if you can’t treat their Hepatitis C. What would you do? Dr. Jeffery Campsen, a transplant surgeon at University of Utah Health Care, tells you how they got to the “ah ha!” moment that solved that problem for one of their patients.

Interview

Interviewer: You have a patient with kidney failure, but you can't treat the kidney failure because the individual also has Hepatitis C. What do you do? You're going to find out how a creative group of doctors solved that problem next on "The Scope."

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Interviewer: It was a little bit of a puzzle, wasn't it? How to treat a patient that has Hepatitis C that also has kidney failure because you cannot use the new drugs for Hepatitis C on somebody that has kidney failure. We're with Dr. Jeffery Campsen. He's a transplant surgeon here at the University of Utah. Tell me about this cool new procedure that could really change the way we think about patients with kidney failure and Hepatitis C.

Dr. Jeffery Campsen: So it's very cool and it's a plan that we developed with our transplant group, and we're just now seeing the fruits come out of it. Basically we have patients that have kidney failure, but they also have an infection with Hepatitis C. There are deceased donors that die and are also infected with Hepatitis C. And those organs can't be used into people that have never been infected with Hepatitis C, but if you are already infected with Hepatitis C, you can accept an organ, a kidney from a donor that has Hepatitis C. And that's what we did.

We looked at our patients that had both, kidney failure and infection with Hepatitis C, and asked them if they would be willing to accept an organ from a Hepatitis C donor.

Interviewer: And I understand there is actually another advantage of somebody that has Hepatitis C being able to accept an infected organ. What is that?

Dr. Jeffery Campsen: Because that allows him to get transplanted sooner. Patients on the transplant list that are on dialysis have a shorter life expectancy. And so if we can get them off of dialysis, they actually increase the amount of time that they are allowed to stay alive. So other people can't accept the Hepatitis C donor because we would infect them with C, but because he could accept, because he already had the Hepatitis, he gets a transplant much sooner which then allows him to live longer.

Interviewer: But then you still have Hepatitis C.

Dr. Jeffery Campsen: That's right. And that's the very interesting part now. So recently there are new medications that have come out that are greater than 90% successful at curing Hepatitis C. However, they're not allowed to be used in patients with kidney failure. So what we decided to do as a group was commit to our patients with kidney failure and hepatitis, and basically saying, "If you get transplanted for your kidney and cured of your kidney disease, then we're willing at the university, after the transplant, to treat your Hepatitis C and cure you of Hepatitis C."

Interviewer: So this patient had kidney failure.

Dr. Jeffery Campsen: Correct.

Interviewer: Also had Hepatitis C.

Dr. Jeffery Campsen: Correct.

Interviewer: But could not get treated for that because of the kidney failure, could not use these brand drugs that have been developed over the past year until his kidney was healthy.

Dr. Jeffery Campsen: That's exactly right.

Interviewer: So we put the new kidney in. He has a healthy kidney. Now you can treat for the hepatitis. It's like a step by step thing.

Dr. Jeffery Campsen: That's exactly right. So we have a multidisciplinary team that looks at the entire health of the patient. And while his kidney disease was his main problem and that needed to be cured, we also have to make sure that after the transplant he lives a long time and protects that kidney. So if he has hepatitis, we also have to treat that.

So six months ago this man was on dialysis with renal failure and active Hepatitis C infection. Six months from now he is off of dialysis with a functioning kidney, cured of his renal failure, and cured of his Hepatitis C infection which will then allow him to live a long life with good quality.

Interviewer: That's amazing.

Dr. Jeffery Campsen: It's very cool and it's just something that with modern medicine that we've been able to put all of these techniques together into a care plan that our patients can benefit from.

Interviewer: Every time something new is invented after it's been invented or the procedure has been concepted, it's like, "Wow! Why didn't we think of this earlier?" Was this one of those deals or was this one of the deals where it was just very obvious that this would be the steps you would take?

Dr. Jeffery Campsen: No, it was something that when it all clicked together it was one of those ah-ha moments. And I think it was a group of transplant professionals sitting around during our selection committee saying, "You know what? I can treat his hepatitis if you guys cure him of his kidney disease." And then someone else says, "Well, he already has Hepatitis C. Can he get a Hepatitis C organ?" So there is a variety of input from multiple different disciplines that all come together and then allow for this very complicated medical plan to be conceived, and then pursued, and then be successful for the patient.

Interviewer: This individual now is going to have a quality of life that would have been unheard of even a couple of years ago.

Dr. Jeffery Campsen: Absolutely. We couldn't have done this a couple years ago and we could have done his transplants, we could have treated him for hepatitis, but the old medications had tons of side-effects and weren't very effective. And so now we took a variety of treatments and put them together with a variety of different physician groups, and allowed him to basically be cured of kidney failure, and cured of Hepatitis C infection allowing him to live a long life.

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