A Phase 1/2 interventional study of C1 Esterase Inhibitor and Placebo in End Stage Renal Disease, Kidney Failure and Delayed Graft Function, sponsored by Cedars-Sinai Medical Center. Completed at 1 site in United States. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2018-06-25.
Sponsored by Cedars-Sinai Medical Center · Phase 1/2, Interventional, and Prevention
The use of C1INH (Berinert) in patients receiving deceased donor kidney transplants with high risk for delayed graft function (DGF) may show significant improvement in outcomes post transplant compared with patients that do not receive C1INH treatment. Complement activation has been detected in animal models and human kidneys with ischemic reperfusion injury (IRI) and inflammatory cell infiltrates. By blocking complement activation the investigators hope to improve kidney graft function post transplant in these recipients.
Early graft function has a long-term effect on graft survival. Poor early graft function and delayed graft function (DGF) contributes to decreased short- and long-term patient and graft survival, increased incidence of acute rejection, prolonged hospitalization, and higher costs of transplantation. Although multiple factors contribute to the impaired graft function, ischemia-reperfusion injury (IRI) is the underlying pathophysiology leading to poor early graft function and DGF. A >35% incidence of DGF has remained constant over time despite significant improvements in immunosuppressive strategies and patient management. This may be due to increased use of kidneys from "extended-criteria" and/or non-heart-beating donors, where even greater rates (>60%) of DGF have been reported.
More than 96,680 people are currently waiting for a kidney transplant in the United States (United Network for Organ Sharing (UNOS); UNOS.org 3/22/13). Of the 15,092 kidney transplants performed in the US in 2011, \~11,000 (62%) were from deceased donors. Of these, approximately 17% were from expanded-criteria donors. The USRDS reports that more than 50% of patients on the waiting list are willing to accept a kidney from an expanded-criteria donor (ECD) or donors after cardiac death (DCD).
From the investigators previous studies with C1INH (Berinert®) for prevention of antibody mediated rejection (ABMR), the investigators noted that no patients developed ABMR during treatment with C1INH, the investigators also noted a near significant reduction in DGF due to IRI (ClinicalTrials.gov(NCT01134510), FDA Investigational New Drug (IND#): 14363). These findings suggest an important role for complement in the mediation of IRI and that inhibition of early complement activation using C1INH in patients receiving at risk kidneys for IRI should reduce this costly and often devastating complication of kidney transplantation. In addition, numerous other studies in animal models have shown dramatic improvements in IRI models with the use of C1INH. Complement activation is detectable in animal and in human kidneys models after IRI and experimental data suggests that use of C1INH prior to induction of IRI significantly reduces IRI as well as inflammatory cell infiltrates. Based on this, the investigators hypothesize that the use of C1INH in patients receiving deceased donor (DD) kidney transplants with high risk for DGF will show significant reductions in DGF and improved outcomes post-transplant compared with patients receiving DD transplants who do not receive C1INH treatment. Here, the investigators propose to investigate the application of pre-operative and post-transplant doses of C1INH (Berinert®) vs. placebo in adult subjects receiving a DD renal allograft considered at high-risk for IRI and DGF. The investigators hypothesize that C1INH treated patients will demonstrate improved function of the kidney allograft compared to placebo, with equivalence in safety. The primary objectives of this study are: Using a double blinded, placebo controlled format, the investigators will:
The secondary objectives are to:
2,108 studies on the registry are indexed under Kidney Failure, Chronic; 273 are open to participants now.
This study's enrollment of 70 is above the median of 57 across 1,569 interventional studies indexed under Kidney Failure, Chronic.
Browse Kidney Failure, Chronic studies →Cedars-Sinai Medical Center is the lead sponsor of 456 studies on the registry; 107 are open to participants now.
Of its 65 completed or terminated interventional studies of FDA-regulated products, 49 (75%) have results posted.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Risk index (minimum 3- maximum 8):
DGF scale: Donor Age (\<40yr = 0, 41-49yr = 1, 50-54yr = 2, 55-59yr = 3, >60yr=6), Cold Ischemia Time (0-12= 0, 13-18=1, 19-24=2, 24-30=3, 31-36=4, >37=6; Recipient Race (nonblack = 0, black =1); Donor death due to Cerebrovascular Accident (CVA) (donor age \<50yrs = 0, donor age >50yrs = 3).
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.
Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
INR, PT and aPTT (clotting tests)
Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.
Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Cancer (malignancy)
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
HIV
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
35 patients will receive C1 esterase inhibitor in addition to standard of care immunosuppressive therapy.
Drug: C1 Esterase Inhibitor
35 patients will receive placebo in addition to standard of care immunosuppressive therapy.
Drug: Placebo
C1 Esterase Inhibitor 50 units per kilogram intravenous infusion administered on day of transplant, and another dose at 24 hours post-operatively. Total: 2 doses
Also known as: Berinert (C1INH)
Placebo medication identical to study drug (C1 esterase inhibitor) volume will be administered on day of transplant, and another dose at 24 hours post-operatively. Total: 2 doses
Also known as: Normal Saline (0.9%NaCl)
Number of Patients Enrolled With Serum Creatinine >3mg/dL on Postoperative Day 5.
Number of participants in the C1INH and placebo groups with serum creatinine \>3mg/dL on postoperative day 5
Time frame: First 7 days post-transplant
Number of Patients Enrolled Who Require at Least One Session of Dialysis in the First 7 Days Post Transplant.
The proportion of patients enrolled who require at least one session of dialysis in the first 7 days post transplant (excluding those who are dialyzed for hyperkalemia).
Time frame: First 7 days post-transplant
Number of Patients With Serum Creatinine Reduction Ratio of < 30% From 24 to 48 Hours Post-transplant.
Number of patients in the C1INH and placebo groups with serum creatinine reduction of \< 30% from 24 to 48 hours post-transplant.
Time frame: First 7 days post-transplant
Number of Dialysis Sessions Per Patient in the First 7 Days Post Transplant.
Mean quantity of dialysis sessions per patient in the first 7 days post transplant.
Time frame: First 7 days post-transplant
Serum Creatinine
Mean serum creatinine on day 90 in mg/dL
Time frame: Up to 90 days post-transplant
Creatinine Clearance
Creatinine clearance calculated based on serum creatinine, milliliters per minute.
Time frame: Up to 90 days post-transplant
24h Urine Output
24 hour urine output post-transplantation measured in milliliters
Time frame: 24 hours post-transplant
Mean Number of Patients on Dialysis
Mean number of patients on dialysis at 15 to 30 days post-transplant
Time frame: 15 to 30 days post-transplantation
Number of Patients With Delayed Graft Function (DGF) (Categorized by DGF Scale)
DGF Scale: Grade 1 - immediate urine production and no need for dialysis with creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation \>70% Grade 2 - creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation of \>70% with need for dialysis Grade 3 - creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation \<70% with no need for dialysis Grade 4 - creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation of \<70% with need for dialysis.
Time frame: First 7 days post-transplant
Overall Incidence of Serious Adverse Events
Overall incidence of serious adverse events in the C1INH and placebo groups, number of events.
Time frame: Up to 9 months post-transplant
Patient Survival
Patient survival at 90 days post-transplantation
Time frame: Up to 90 days post-transplant
Rate of Acute Cellular Rejection (ACR)
Number of acute cellular and antibody mediated rejection episodes by day 90.
Time frame: Up to 90 days post-transplant
Graft Survival
Number of Participants with Graft Survival at 90 Days Post-Transplant
Time frame: Day 90 Post-transplant
| Milestone | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Started | 35 | 35 |
| Completed | 34 | 34 |
| Not completed | 1 | 1 |
Number of participants in the C1INH and placebo groups with serum creatinine \>3mg/dL on postoperative day 5
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Number of Patients Enrolled With Serum Creatinine >3mg/dL on Postoperative Day 5. | 29 | 32 |
The proportion of patients enrolled who require at least one session of dialysis in the first 7 days post transplant (excluding those who are dialyzed for hyperkalemia).
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Number of Patients Enrolled Who Require at Least One Session of Dialysis in the First 7 Days Post Transplant. | 15 | 21 |
Number of patients in the C1INH and placebo groups with serum creatinine reduction of \< 30% from 24 to 48 hours post-transplant.
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Number of Patients With Serum Creatinine Reduction Ratio of < 30% From 24 to 48 Hours Post-transplant. | 30 | 28 |
Mean quantity of dialysis sessions per patient in the first 7 days post transplant.
| dialysis sessions | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Number of Dialysis Sessions Per Patient in the First 7 Days Post Transplant. | 0.97 ± 1.22 | 1.54 ± 1.54 |
Mean serum creatinine on day 90 in mg/dL
| mg/dL | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Serum Creatinine | 1.3 ± 0.317 | 1.7 ± 1.410 |
Creatinine clearance calculated based on serum creatinine, milliliters per minute.
| ml/minute | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Creatinine Clearance | 56.4 ± 15.558 | 51.2 ± 17.335 |
24 hour urine output post-transplantation measured in milliliters
| milliliters | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| 24h Urine Output | 873.5 ± 1257.0 | 607.8 ± 782.4 |
Mean number of patients on dialysis at 15 to 30 days post-transplant
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Mean Number of Patients on Dialysis | 0 | 5 |
DGF Scale: Grade 1 - immediate urine production and no need for dialysis with creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation \>70% Grade 2 - creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation of \>70% with need for dialysis Grade 3 - creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation \<70% with no need for dialysis Grade 4 - creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation of \<70% with need for dialysis.
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Number of Patients With Delayed Graft Function (DGF) (Categorized by DGF Scale) | 15 | 21 |
Overall incidence of serious adverse events in the C1INH and placebo groups, number of events.
| events | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Overall Incidence of Serious Adverse Events | 11 | 16 |
Patient survival at 90 days post-transplantation
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Patient Survival | 35 | 35 |
Number of acute cellular and antibody mediated rejection episodes by day 90.
| episodes | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Rate of Acute Cellular Rejection (ACR) | 0 | 0 |
Number of Participants with Graft Survival at 90 Days Post-Transplant
| Participants | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Graft Survival | 34 | 34 |
Collected over Adverse event data collected up to 9 months post transplant.. Non-serious events are listed at a 3% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| C1-Inhibitor (Berinert) (Human) (C1INH) | 0/35 (0%) | 10/35 (28.6%) | 28/35 (80%) |
| Normal Saline | 0/35 (0%) | 10/35 (28.6%) | 26/35 (74.3%) |
| Event | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| Abdominal painGastrointestinal disorders | 1/35 | 2/35 |
| BacteremiaInfections and infestations | 1/35 | 0/35 |
| Neutropenia/FeverInfections and infestations | 1/35 | 1/35 |
| Viral infectionInfections and infestations | 1/35 | 0/35 |
| Purulent Drainage from woundInfections and infestations | 1/35 | 0/35 |
| Acute EncephalopathyInfections and infestations | 0/35 | 1/35 |
| Sepsis from Urinary Tract InfectionInfections and infestations | 0/35 | 1/35 |
| Diabetic KetoacidosisEndocrine disorders | 1/35 | 0/35 |
| Flash pulmonary edemaRespiratory, thoracic and mediastinal disorders | 1/35 | 0/35 |
| Dyspnea on exertionRespiratory, thoracic and mediastinal disorders | 1/35 | 0/35 |
| Event | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline |
|---|---|---|
| HyperkalemiaMetabolism and nutrition disorders | 7/35 | 7/35 |
| HypertensionCardiac disorders | 1/35 | 7/35 |
| NauseaGastrointestinal disorders | 3/35 | 7/35 |
| EdemaCardiac disorders | 7/35 | 4/35 |
| FatigueGeneral disorders | 2/35 | 5/35 |
| ConstipationGastrointestinal disorders | 3/35 | 3/35 |
| VomitingGastrointestinal disorders | 2/35 | 3/35 |
| Shortness of BreathCardiac disorders | 1/35 | 3/35 |
| HyperglycemiaEndocrine disorders | 2/35 | 0/35 |
| HypotensionCardiac disorders | 1/35 | 2/35 |
| Age, Continuous(years) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Mean | 57.66 ± 7.74 | 58.14 ± 11.18 | 57.9 ± 9.54 |
| Sex: Female, Male(Participants) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Female | 15 | 13 | 28 |
| Male | 20 | 22 | 42 |
| Race/Ethnicity, Customized(Participants) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| African-American | 4 | 4 | 8 |
| Not African-American | 31 | 31 | 62 |
| Diabetes(Participants) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Count of participants | 21 | 20 | 41 |
| Donor Age(years) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Mean | 49.17 ± 12.35 | 45.57 ± 15.69 | 47.37 ± 14.13 |
| Donor Creatinine(mg/dL) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Mean | 1.78 ± 1.44 | 1.75 ± 1.92 | 1.77 ± 1.69 |
| Donor DCD Cause of Death(Participants) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Count of participants | 11 | 12 | 23 |
| Donor KDPI(%) | C1-Inhibitor (Berinert) (Human) (C1INH) | Normal Saline | Total |
|---|---|---|---|
| Mean | 67.71 ± 21.83 | 64.63 ± 25.39 | 66.17 ± 23.56 |
7 further baseline measures are reported on the registry.
PDFs hosted by the registry, ClinicalTrials.gov.
The record gives a start of Sep 2014, a primary completion of Mar 2017 and a completion of Mar 2017. It does not say whether these dates are actual or estimated.
Results were first posted in Jun 2018, 1 year 3 months after primary completion.
How these figures are worked out, and which studies are left out of them.
This study is completed, as verified in Jun 2018. You cannot join it, but the record below documents what was studied.
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Studies of the drug tested here: Complement C1 Inhibitor Protein