LiverHope

Fewer Living Organ Donors Widens Need Gap

Drop in Kidney, Liver and Lung Donations Resulting in Need Gap, Study Finds

MSNBC – March 22, 2010 - The number of living organ donors is on the decline, according to a new study. The results show that overall, living kidney, liver, and lung donations have decreased over the last five years, going from about 7,000 in 2004 to 6,219 in 2008.

In addition, organs from deceased donors went down for the first time in 2008. Until then, the number of deceased donors had always increased compared to the previous year.

"This decline has resulted in a widening gap between the number of organs available for transplant, and the number of patients who are awaiting a donor organ," said study author Andrew S. Klein, M.D., director of Cedars-Sinai Medical Center's Comprehensive Transplant Center in Los Angeles.

The study looked at trends in organ donation between 1999 and 2008. In that time frame, only the number of living kidney donors increased, but this rise actually occurred between 1999 and 2004 and the numbers have fallen each year since.

Among other donation groups, living liver donors dropped in 2008 to less than 50 percent of their peak (524) in 2001. There were 58 living lung donors in 1999, but no living lung donors in 2008.

While the number of deceased donors increased steadily between 2003 and 2006, it reached a plateau in the middle of the decade, and slightly dipped in 2008, going from 28,405 in 2007 to 27,958.

More opt for transplant
The news comes just days after Apple CEO Steve Jobs announced plans to help expand California's organ donation program. On March 19, Jobs revealed publically that he had received a liver transplant in Memphis because there were not enough donors in California, according to the San Jose Mercury News.

Jobs discussed ideas with the states' governor, Arnold Schwarzenegger, and the governors' office is working on a bill to require all those applying for California driver's licenses to answer whether or not they would be an organ donor in the event of their death. Currently, the state's Department of Motor Vehicles does not require applicants to answer that question before receiving a license.

"Ironically, the single largest factor in today's donor organ shortfall is that solid organ transplants have become so successful," Klein said.

"Improved survival rates and the expectation that organ replacement will enhance quality of life have encouraged more doctors and their patients with organ failure to opt for transplantation," he added.

The study also identified a number of other factors that could be contributing to the organ shortage. These include:

"This study showed that many people have questions and concerns about organ donation," Klein noted.

"Educating the public and improving transparency of the organ donation and transplantation process and performance are critical to narrowing the donor organ gap."

The results were published online in the American Journal of Transplantation.

C-SICK-a haunting and enlightening journey of “Polly”, one of over 5 million people infected with Hepatitis C. Theatre provocateurs Ranek and Weiland wander away from their comedic roots to examine what it’s like to live with this silent killer. They challenge the stigma that this is only a drug abusers’ disease, and weave a tale that entertains, educates and reveals the humanity of Hep C.

Before 1992 blood wasn’t screened for the Hep C virus. It can lay dormant for more than 20 years and is now in epidemic proportions. Haven’t heard? You should!

Ranek and Weiland of IOU productions continue their effort to shed light on one of this country’s most serious, yet correctable, shortages, and the need for organ donation. It seems so simple. It makes so much sense. You need to see this show.

January 24, 2010 - In the January 2010 Journal of Clinical Gastroenterology, S. Sockalingam and colleagues presented a review of sleep disturbances in people with HCV.

Up to 60% of patients with chronic hepatitis C experience sleep problems, which are often related to existing psychiatric conditions such as depression.

Neuropsychiatric side effects of interferon may also manifest as sleep problems, and up to 30% of interferon-treated patients have newly diagnosed sleep disturbances. Since insomnia in people with hepatitis C may be influenced by a variety of coexisting conditions—both psychiatric (such as depression) and medical (such as anemia or hypothyroidism)—screening to promptly recognize or exclude co-morbid conditions can enhance treatment outcomes.

In conclusion, the authors wrote, "Further research is needed to elucidate the efficacy of pharmacological and non-pharmacological treatments of sleep disorders in chronic hepatitis C patients."

Source: HEPATITIS JOURNAL REVIEW: A Bi-Monthly Publication of the Hepatitis Support Project

Rockefeller University Researchers Develop Method for Growing Hepatitis C Virus in Healthy Human Liver Cells

SUMMARY: Research on the lifecycle of hepatitis C virus (HCV) and development of effective therapies has been hampered by the fact that the virus is difficult to grow in liver cells in the laboratory; instead, investigators have used "replicon" models or a specific strain of HCV in cancerous liver cells. But now, researchers at the Massachusetts Institute of Technology (MIT) and Rockefeller University have found a way to sustain viral replication for up to 3 weeks in healthy liver cells, as reported in the February 1, 2010 advance online issue of Proceedings of the National Academy of Sciences.

Advance that could allow scientists to develop and test new treatments for the disease

Cambridge, Mass. -- January 25, 2010 -- Researchers at MIT and Rockefeller University have successfully grown hepatitis C virus in otherwise healthy liver cells in the laboratory, an advance that could allow scientists to develop and test new treatments for the disease.

About 200 million people worldwide are infected with hepatitis C, which can lead to liver failure or cancer, and existing drugs are not always effective. To develop better treatments, researchers need to test them in laboratory experiments in liver cells, but it has been difficult to create a suitable tissue model because healthy liver cells tend to lose their liver functions when removed from the body.

Previously, researchers have been able to induce cancerous liver cells to survive and reproduce outside the body, but those cells are not sufficient for studying hepatitis C because their responses to infection are different from those of normal liver cells.

Now, Sangeeta Bhatia, professor in the Harvard-MIT Division of Health Sciences and Technology, in collaboration with Charles Rice of the Rockefeller University, has developed a way to maintain liver cells for four to six weeks by precisely arranging them on a specially patterned plate. The cells can be infected with hepatitis C for two to three weeks, giving researchers the chance to study the cells' responses to different drugs.

The new model, described in next week's issue of the Proceedings of the National Academy of Sciences, could allow researchers to test the effectiveness of various combinations of drugs, including interferon, a common current treatment, and experimental antibodies that may block the virus from entering cells.

How they did it: The researchers used healthy liver cells that had been cryogenically preserved and grew them on special plates with micro patterns that direct the cells where to grow. The liver cells were strategically interspersed with other cells called fibroblasts that support the growth of liver tissue.

"If you just put cells on a surface in an unorganized way, they lose their function very quickly," says Bhatia. "If you specify which cells sit next to each other, you can extend the lifetime of the cells and help them maintain their function."

Next steps: The current system may already be suitable to screen drugs against the strain of hepatitis C used in this work; however, this strain, which was derived from a Japanese patient with fulminant hepatitis is the only strain ever successfully grown in a laboratory environment. The researchers hope to modify the system so they can grow additional strains, such as those more

References: A Ploss, SR Khetani, CT Jones, and others. Persistent hepatitis C virus infection in microscale primary human hepatocyte cultures. Proceedings of the National Academy of Sciences USA (Abstract). February 1, 2010

Source: Massachusetts Institute of Technology. Engineering a new way to study hepatitis C. News release. January 25, 2010.

In January 2008, we started offering a quarterly cirrhosis patient education evening lecture series and forum for patients with cirrhosis. The meetings are held on the third Tuesday in January, April, July and October from 6:30 – 8:30 p.m. at the Division of Gastroenterology, located in the 3^rd floor conference room of the VFW building, 406 Harvard St. S.E., Minneapolis, MN 55455.

We hope you can join us. If you have any questions about the program or need directions, please call Aynsley Smith at 612-625-8438 or email at smit0288@umn.edu.

NVHR Warns ‘Systemic Underfunding’ of Federal Viral Hepatitis Program Puts 5 Million Americans at Risk

WASHINGTON, March 16, 2010 /PRNewswire-USNewswire/ -- Warning that "systemic underfunding of the Centers for Disease Control's Division of Viral Hepatitis puts millions of Americans' health and well-being at risk," the National Viral Hepatitis Roundtable (NVHR) today called on the Administration to work with Congress to take decisive action this year to fix the funding failure for viral hepatitis screening, surveillance, and early intervention programs. While an estimated 5 million Americans are infected with viral hepatitis B or C, the Administration's budget proposal for 2011 would fund the Division of Viral Hepatitis at a level actually lower than allocated a decade ago during the Clinton Administration. The Administration's neglect is particularly troubling given a recent Institute of Medicine (IOM) report blasting the federal government for its inadequate response to this crisis.

NHVR Chair Lorren Sandt was joined at a Capitol Hill press briefing today by NVHR Steering Committee Member Andrew Muir, M.D. of the Duke University School of Medicine. In addition, four Members of Congress participated in the briefing: Representative Hank Johnson, Democrat of Georgia who recently completed treatment for hepatitis C; Representative Mike Honda, Democrat of California, who is the lead sponsor of HR 3974, which would provide $90 million in new federal funding for the CDC's viral hepatitis screening, surveillance, and early intervention programs; and Representative Anh "Joseph" Cao and Representative Mike Cassidy, M.D., both of whom are Republican cosponsors of HR 3974 from Louisiana. Congressman Cassidy is also a practicing hepatologist.

"NVHR applauds Congressmen Johnson, Honda, Wu, Cao, and Cassidy for their steadfast, bipartisan commitment to providing adequate funding for viral hepatitis screening, surveillance, and early intervention programs benefiting 5 million Americans," said Ms. Lorren Sandt, NVHR Chair and Executive Director of Caring Ambassadors Program, based in Portland, OR. "With the window of opportunity to address this crisis rapidly closing, NVHR urges action this year on the bipartisan Honda-Dent legislation. Otherwise, the federal government's systemic underfunding of viral hepatitis programs will continue to put millions of Americans at risk, particularly in the African American and Asian American communities."

The CDC's National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention (NCHHSTP) is the umbrella federal agency overseeing the Division of Viral Hepatitis (DVH). The Administration's FY 2011 budget proposal calls for a $1.8 million increase for the Division of Viral Hepatitis, a marked improvement from last year's meager Administration proposal of $51,000. Still, the Division of Viral Hepatitis annual budget accounts for just two percent of the entire annual NCHHSTP budget. Perhaps most tellingly, the Administration's total 2011 budget proposal for DVH of $21 million is still less than the $25 million in annual funding that was allocated ten years ago. Meanwhile, the depth and breadth of this crisis has only worsened.

Bipartisan legislation, HR 3974, "The Viral Hepatitis and Liver Cancer Control and Prevention Act," sponsored by Representatives Mike Honda (D-Calif.), Charles Dent (R-Pa.) and 29 other House Members would correct this shortfall. The Honda-Dent legislation would increase the ability of the CDC to support state health departments in their prevention, immunization and surveillance, and referral to care efforts. Much of the Honda-Dent legislation tracks with the IOM's recommendations.

With roughly 1 in 50 Americans afflicted with chronic viral hepatitis B or C – and an overwhelming majority unaware they are infected – millions of Americans are at risk, especially African Americans and Asian Americans. Without detection and treatment, chronic viral hepatitis leads to liver cancer, cirrhosis, or liver failure. In the absence of federal leadership, the research firm Milliman estimates that public and private payers' cost of treating chronic viral hepatitis C alone will more than triple by 2024 to $85 billion. Medicare and Medicaid would absorb a disproportionate share of these added costs.

"As a practicing hepatologist, every day I see the staggering human and economic costs associated with a lack of screening, surveillance, and early intervention for viral hepatitis," said Dr. Andrew Muir. "Fully 80 percent of US liver cancers could be prevented if we provided a relatively modest increase in federal funding for these programs. Without decisive action this year from Washington, millions of Americans will continue to be at risk and the cost to the health care system will be overwhelming."

NVHR is a coalition of more than 150 public, private, and voluntary organizations dedicated to reducing the incidence of infection, morbidity, and mortality from chronic viral hepatitis that afflicts more than 5 million Americans. www.nvhr.org

Los Angeles Times – February 26, 2010 - Animal studies are typically a key step in the scientific process, but some illnesses are especially challenging to study in this manner. For example, the liver diseases hepatitis B and hepatitis C can infect only humans and chimpanzees. Scientists also have had a hard time trying to study liver infections because human liver cells don't grow well in a lab culture.

That explains why researchers at the Salk Institute in La Jolla are particularly pleased with a new rodent resident in their labs -- a mouse with a human liver. The humanized mouse will make it possible to test new therapies for human liver diseases, such as hepatitis and malaria.

To create the model, researchers began with a special mouse with liver problems that could be treated with a particular drug. By taking away the drug, the researchers got human liver cells to take hold and populate the mouse liver. Tweaking the technique produced a mouse liver 95% composed of human liver cells. Studies showed the mouse liver could be infected with hepatitis B and hepatitis C and that the standard treatment for hepatitis C effectively treated the infection.

"This robust model system opens the door to utilize human [liver cells] for purposes that were previously impossible," Inder Verma, the senior author of the study, said in a news release. "This chimeric mouse can be used for drug testing and gene therapy purposes, and in the future, may also be used to study liver cancers."

iJohn Lake, M.D. is Professor of Medicine and Surgery at the University of Minnesota Medical School. He is currently the Director of the Gastroenterology Division and is the Director of the Liver Transplant Program at Fairview University Medical Center.

Dr. Lake earned his M.D. degree at the University of Minnesota Medical School. He completed his training in Internal Medicine and Gastroenterology at the University of California San Francisco. He was previously on the faculty at the University of California San Francisco.

Dr. Lake is an internationally known transplant hepatologist and active member of the medical community. He has published extensively, including over 135 scientific papers, over fifteen reviews, and over twenty book chapters. Dr. Lake has an active research program, with primary research interests in post-transplant hepatitis C, and outcome predictors for liver transplant results. He also works with the development of new immunosuppressive agents.

Dr. Lake is a past president of the American Society of Transplantation. He currently serves as the co-Chair of the UNOS Liver and Intestine Committee. He is the Editor of Transplantation Facts, and also an Associate Editor of the American Journal of Transplantation and Transplantation Proceedings.