GASTROENTEROLOGY/HEPATOLOGY

Robert Gholston received an investigational drug regimen that resolved his hepatitis C after a liver transplant.

Out of the woods

Groundbreaking hepatitis C drug combination saves liver transplant patient

issue 19 | Fall 2013

When he was just nine years old, Robert Gholston was in a car accident and received a blood transfusion. It may have saved his life, but likely infected him with a disease that he wouldn't discover for years.

Gholston was a consistent blood donor until the late 70s, when the Red Cross started screening blood products for the hepatitis C virus. The healthy 29-year-old was shocked to learn he had hepatitis C.

The usual drug treatments for hepatitis C didn't work too well for Gholston, and by 2011 he got so sick that his only option was a liver transplant.

A NEW LIVER, THEN A NEW LEASE ON LIFE

After receiving that transplant, he met with Robert Fontana, M.D., at the University of Michigan, who had some grim but not expected news: A new liver doesn't stop the hepatitis C virus. It could come back.

Within six months, hepatitis C was aggressively attacking Gholston's new liver. But Fontana, professor of Internal Medicine and medical director of Liver Transplantation, offered Gholston some hope: a new oral drug regimen never tried before. Fontana wanted to pursue using a combination of sofosbuvir and daclatasvir combination therapy, an interferon-free, all oral regimen. The drugs were co-administered for 24 weeks. Within four weeks of initiating the treatment, serum HCV RNA levels were undetectable and liver biochemistries normalized.

Gholston is now hepatitis C-free. He is 59, lives in Troy, Mich., with his wife, and works as a durability test driver/trainer at General Motors. He's a father of eight, grandfather of eight and walks five miles a day. "I hope this provides hope for others in this situation," says Gholston, who also has had diabetes and coronary artery disease. "I feel great."

Fontana says it definitely does. The case was published in the American Journal of Transplantation in January 2013.

GREAT PROMISE

"The rapid and sustained suppression of hepatitis C in Mr. Gholston provides great promise for the use of these combination oral antiviral regimens in other transplant recipients," says Fontana. "Recurring hepatitis C is very challenging to manage and this shows there is a safer and more effective treatment option."

Hepatitis C is the leading indication for liver transplantation in the United States and many parts of the world. However, patient survival is significantly lower in patients with hepatitis C compared to other recipients, due in part to the inevitable recurrence of hepatitis C infection.

"This case illustrates that the use of potent oral antiviral agents such as daclatasvir and sofosbuvir, even early after transplantation, offers great promise to the many HCV patients worldwide who are experiencing reduced quality of life and survival because of recurrent infection," Fontana says.

There's an urgent need to develop better therapies for liver transplant recipients to combat the recurrence of hepatitis C. According to the Annals of Internal Medicine, by 2007, hepatitis C had superseded HIV as a leading cause of death in the United States, and deaths from hepatitis C and hepatitis B disproportionately occurred in middle-aged persons. It is a growing, serious health problem among aging baby boomers.

A THANKFUL PATIENT

Gholston is thankful for yet another second chance at life. He said he was never too anxious about trying a new drug combination: "Dr. Fontana said no one else has ever taken it, but I knew I didn't have another choice. But with every step, Dr. Fontana was so calm with it. And me being a man of faith, I think what God is going to do, God is going to do. I really had peace with it."

Gholston is trying to give back, and has established a close relationship with the family of his donor, playing Santa Claus to the donor's son and planning for camping trips. Gholston, who is African-American, has been active with promoting organ donation awareness among minorities through Gift of Life Michigan and its Detroit Minority Organ Tissue Transplant Education Program (MOTTEP).

"Every single day I think about that donor, and I am grateful for that gift and the chance to be healthy that this treatment gave me. I really hope it helps others," says Gholston.

Also In This Article:

Read more about Robert Fontana, M.D.

Marie Janus recently received the 2000th liver transplant at U-M. Watch a video and read about her story.