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Status unknownNCT03465397BIOIMMUNUpdated Jan 8, 2021

Individualization of the Immunological Risk Based on Selective Biomarkers in Living-donor Renal Recipients

A Phase 4 interventional study of biomarkers driven immunosuppressive therapy in Kidney Transplant Failure and Rejection, sponsored by ORIOL BESTARD. Status unknown at 6 sites in Spain. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-01-08.

Sponsored by ORIOL BESTARD · Phase 4, Interventional, and Prevention

The sponsor has not verified this record recently (last verified Jan 2021), so the status shown — last known as Recruiting — may be out of date.
Phase
Phase 4
Study type
Interventional
Enrollment
164
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This is a clinical trial comparing the immunosuppressive treatment determined according to two biomarkers, donor-specific IFN-γ ELISPOT and Mismatch of HLA between donor and recipient, in patients undergoing low immunological risk live donor kidney transplantation

Read the detailed description

This is a national multicenter clinical trial, controlled, randomized, stratified, parallel groups, and without masking.

This is a prospective intervention study in which two strategies for determining immunosuppressive treatment in kidney transplant patients from a live donor with low immunological risk are compared according to solid phase antibody detection techniques (cPRA 0% and isolated negative antigen) and crossmatch by negative cytotoxicity. Patients are randomized in a 1: 1 ratio to receive one of two immunosuppressive treatment strategies.

02

Conditions studied

  • Kidney Transplant Failure and Rejection
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Adult men and women (≥18 years).
  2. Receptors of a first kidney transplant from an incompatible HLA living donor (at least 1 mismatch HLA at any antigenic level).
  3. AB0 compatible transplant.
  4. Patients with a calculated PRA of 0% by solid phase technique and absence of anti-HLA class I and class II antibodies by single antigen test (Luminex®).
  5. Patients who agree to participate in the Trial by signing the Specific Informed Consent of this study.
  6. Potentially fertile women should use high reliability contraceptive methods (Pearl-Index \<1) in order to avoid pregnancy during the entire duration of the study and up to 6 weeks after the end of their treatment with Mycophenolate Mofetil (MMF). Potentially Fertile Women include any woman who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation or bilateral oophorectomy) or who is not post-menopausal (defined as amenorrhea ≥ 12 consecutive months, or women who are receiving hormone replacement therapy with a documented level of follicle stimulating hormone (FSH)> 35 mlU / ml). Potentially fertile women must have a pregnancy test with a negative result in the 72 hours prior to the start of the trial.
  7. Sexually active males (including vasectomized males) who are being treated with MMF must accept the use of barrier contraceptive methods during MMF treatment and for 90 days thereafter. Potentially fertile partners of these patients should use a reliable contraceptive method during the same period, in order to minimize the risk of pregnancy.
  8. Patients must agree not to donate blood during treatment with MMF and during the 6 subsequent weeks. Males should not make a sperm donation during MMF treatment and up to 90 days after completion.

Exclusion criteria

Exclusion Criteria:

  1. Patients with a calculated PRA higher than 0% per solid phase and / or anti-HLA class I and / or class II antibodies detectable by single antigen test (Luminex®).
  2. Positive result of Cross Match.
  3. Patients who receive a graft from a cadaver donor.
  4. Identical HLA patients
  5. Patients who have undergone a previous solid organ transplant (including kidney transplant) or who are going to receive another solid organ transplant concomitantly.
  6. Patients with any of the following basic renal diseases:

    • Glomerular primary focal and segmental sclerosis
    • Atypical hemolytic uremic syndrome (aHUS) / thrombotic thrombocytopenic purpura syndrome.
  7. Patients with chronic infection with Hepatitis B virus (HBV) and / or active infection with Hepatitis C virus (positive PCR result) at the time of transplant.
  8. Patients with infection with the known Human Immunodeficiency Virus (HIV).
  9. Patients with active systemic infection that requires the continued administration of antibiotics.
  10. Patients with any neoplasm except localized skin cancer and who is receiving adequate treatment.
  11. Patients with severe anemia (hemoglobin \<6g / dl), leukopenia (WBC \<2500 / mm3) and / or thrombocytopenia (platelets \<80,000 / mm3).
  12. Patients who are hemodynamically unstable even if they have hemoglobin levels> 6g / dL.
  13. Patients with intestinal pathology or severe diarrhea that may decrease absorption according to medical criteria.
  14. Patients with known hypersensitivity to any of the drugs used in this study.
  15. Patients who have received any investigational drug in the 30 days prior to their inclusion in this study.
  16. Potentially fertile women who do not agree to use reliable contraceptive measures during the trial, who are pregnant, breastfeeding or who present a positive pregnancy test at the time of their inclusion in the study.
  17. Patients who are legally detained in an official institution.
04

Study design

Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
164 participants (estimated)

Study arms

  • Experimental
    experimental

    Biomarkers driven immunosuppressive therapy: the immunosuppressive treatment of the patients is determined according to the result of 2 biomarkers of immunological risk

    Diagnostic Test: biomarkers driven immunosuppressive therapy

  • No intervention
    control

    All patients receive the usual triple immunosuppressive treatment, without depending on the results of any biomarker.

Interventions

  • Diagnostic testbiomarkers driven immunosuppressive therapy

    the immunosuppressive treatment of the patients is determined according to the result of 2 biomarkers of immunological risk

05

What researchers measure

Primary outcomes

  1. composite

    composite variable evaluated at 2 years of follow-up as a proportion of patients who meet any of the following criteria: loss of renal function, incidence of acute clinical rejection confirmed by biopsy (BPAR) and development of dnDSA.

    Time frame: 24 months

Secondary outcomes

  1. mortality

    Mortality from any cause

    Time frame: 24 months

  2. kidney graft loss

    Loss of kidney graft

    Time frame: 24 months

  3. Subclinical and chronic rejection

    Incidence and severity of subclinical and chronic rejection (according to protocol biopsies)

    Time frame: at 3 and 24 months

  4. Opportunistic infections

    Incidence of opportunistic infections

    Time frame: 24 months

  5. Metabolopathies

    Incidence of metabolopathies derived from the treatment (diabetes mellitus, dyslipidemia and HT)

    Time frame: 24 months

  6. Cardiovascular Events

    Incidence of cardiovascular events

    Time frame: 24 months

  7. Malignancy

    Incidence of malignancy (cutaneous and non-cutaneous cancer)

    Time frame: 24 months

  8. Treatment maintenance

    Proportion of patients who maintain the treatment according to the protocol at the end of the trial.

    Time frame: 24 months

  9. Immune Response Changes

    Changes in the immune response at 24 months according to the biomarkers (urine cytokines CXCL9 and CXCL10, test KSORT, ELISPOT)

    Time frame: 24 months

  10. Economic cost

    Study of the economic cost

    Time frame: 24 months

  11. Serious adverse reactions

    serious adverse events with a possible causal relationship with the immunosuppressive treatment)

    Time frame: 24 months

06

Study locations

5 of 6 sites recruiting
  • Hospital Universitari de Bellvitge
    L'Hospitalet de Llobregat, Barcelona 08907, Spain
    • Carolina Polo, PhD · Contact · cpolo@idibell.cat · +34 93 260 73 85
    • Eulàlia Molinas · Contact · emolinas@idibell.cat · +34 93 260 73 85
    • ORIOL BESTARD, DR · Principal investigator
    • EDOARDO MELILLI, DR · Sub investigator
    Recruiting
  • Hospital Universitari Germans Trias I Pujol
    Badalona, Spain
    Recruiting
  • Fundació Puigvert
    Barcelona, Spain
    Recruiting
  • Hospital Clinic
    Barcelona, Spain
    • FRITZ DIEKMANN, DR · Contact · FDIEKMAN@clinic.cat
    • FRITZ DIEKMANN, DR · Principal investigator
    Not yet recruiting
  • Hospital Del Mar
    Barcelona, Spain
    Recruiting
  • Hospital Universitari Vall D'Hebrón
    Barcelona, Spain
    • FRANCESC MORESO, DR · Contact
    • · Contact · fjmoreso@vhebron.net
    • FRANCESC MORESO, DR · Principal investigator
    Recruiting
07

Registry details

Key details

Study ID
NCT03465397
Lead sponsor
ORIOL BESTARD
Collaborators
Department of Health, Generalitat de Catalunya
Responsible party
ORIOL BESTARD (Head of Transplant Unit, Hospital Universitari de Bellvitge) — Sponsor-investigator
First posted
Mar 14, 2018
Start date
Nov 10, 2017
Primary completion
Nov 2021 (estimated)
Completion
Nov 2021 (estimated)
Last update
Jan 8, 2021

Study contacts

CAROLINA POLO, PhD
Contact
cpolo@idibell.cat
+34 93 260 73 85
EULÀLIA MOLINAS, Pharmacist
Contact
emolinas@idibell.cat
+34 93 260 73 85

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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