ClinicalTrials.gg
Status unknownNCT03791476Updated Dec 14, 2020

RUCONEST® as a Therapeutic Strategy to Reduce the Incidence of Delayed Graft Function

A Phase 1 interventional study of rhC1INH and Saline Solution in Kidney Failure, sponsored by University of Wisconsin, Madison. Status unknown at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-12-14.

Sponsored by University of Wisconsin, Madison · Phase 1, Interventional, and Treatment

The sponsor has not verified this record recently (last verified Jul 2020), so the status shown — last known as Recruiting — may be out of date.
Phase
Phase 1
Study type
Interventional
Enrollment
20
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

An unmet medical need exists for therapeutic regimens in transplantation that allow immediate postoperative graft function, thereby improving graft survival. Delayed graft function (DGF) after transplantation is the most common complication affecting kidney allographs in the immediate transplant period. The specific aim of this study is to evaluate the effect of recombinant human C1-inhibitor (rhC1INH), as a kidney recipient intra- and post operative treatment strategy to decrease systemic inflammation and decrease the incidence of DGF from donation after cardiac death donors (DCD).

Read the detailed description

This is a randomized, single-center double blinded study.

The main objective of this study are to determine the ability of rhC1INH to reduce the incidence and severity of delayed graft function in comparison to placebo in recipients of kidneys after cardio-circulatory determination of death (DCD).

This trial has specifically been designed to evaluate the protective effect of rhC1INH treatment in patients at high risk of developing DGF. The selection of potential donors to be part of this study will be limited to the population of DCD donors which have historically shown a risk of developing DGF ranging between 40-55%. Participation in each group will be randomly assigned. Treatment will be administered by an intra-operative infusion of placebo or rhC1INH (100 Units/kg) IV followed by twice a day infusion of 50 Units/Kg IV for the following 48 hours.

A total of 20 subjects will be divided into 2 groups:

Group 1: Control group: standard recipient management + placebo (0.9% Sodium Chloride IV to equal volume of investigational arm: intraoperatively, and then every 12 hours x 2 = total of 3 doses). treatment (n=10) Group 2: Standard recipient management + 100 U/kg intraoperative followed by 50 U/kg every 12 hours x 2 = total of 3 doses (200 U/kg).

Max dose 8400 units for the initial dose and 4200 units maximum for the second and third doses.

02

Conditions studied

  • Kidney Failure

Keywords

  • Delayed graft function
03

In context

Renal Insufficiency

1,409 studies on the registry are indexed under Renal Insufficiency; 143 are open to participants now.

This study's planned enrollment of 20 is below the median of 40 across 1,058 interventional studies indexed under Renal Insufficiency.

Browse Renal Insufficiency studies →

Lead sponsor

University of Wisconsin, Madison is the lead sponsor of 1,188 studies on the registry; 181 are open to participants now.

Of its 157 completed or terminated interventional studies of FDA-regulated products, 118 (75%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

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

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.

Inclusion criteria

Adult patients receiving a transplanted kidney should satisfy the following to be considered part of the study:

  1. Has the ability to understand the requirements of the study, is able to provide written (including consent for the use and disclosure of research related health information).
  2. Male or female at least 18 years of age.
  3. Is to be a recipient of a transplant from a deceased donor (donation after cardio-circulatory determination of death criteria).
  4. Is able to comply with standard of care induction therapy requirement, such as antibody induction therapy with rabbit polyclonal anti-thymocyte globulin,anti-CD25 (anti-IL2R), or Anti-CD52.
  5. A female subject is eligible to enter the study if she is:

    1. Not pregnant or nursing
    2. Of non- (i.e., defined as having been amenorrheic for at least 1 year prior to screening, or has had a bilateral tubal ligation at least 6 months prior to administration of study drug or bilateral oophorectomy or complete hysterectomy).
    3. If of childbearing potential, must have a negative serum pregnancy test within 48 hours prior to transplant surgery and be using an effective means of (per the site-specific guidelines or using 2 methods of birth control concurrently, whichever is more stringent) which will be continued until the Day 180 visit.
  6. Male subjects with female partners of childbearing potential must agree to use an effective means of contraception (per the site-specific guidelines or use 2 methods of birth control concurrently, whichever is more stringent), which will be continued until the Day 180 visit. They will also agree not to donate sperm until 6 months after dosing.
  7. Must be up-to-date on cancer screening according to site-specific guidelines and past medical history must be negative for -confirmed within 5 years of randomization, with the exception of adequately treated basal cell or squamous cell carcinoma in situ or carcinoma of the cervix in situ.
  8. Must be willing to comply with the protocol procedures for the duration of the study, including scheduled follow-up visits and examinations.

Exclusion criteria

Exclusion Criteria for Transplant Recipients:

  1. Use of an drug in the 30 days before surgery.
  2. Participation in any other research study (drug or non-drug) without prior approval from the sponsor investigator.
  3. Recipient of a live donor kidney or a kidney from a brain death donor (DBD) donor.
  4. Recipient of donor kidney preserved with normothermic machine perfusion.
  5. Scheduled to undergo multiorgan transplantation.
  6. Has a planned transplant of kidneys that are implanted en-bloc (dual kidney transplantation).
  7. Has planned transplant of dual kidneys (from the same donor) transplanted not en-bloc.
  8. Has lost first kidney transplant due to graft thrombosis.
  9. Is scheduled for transplantation of a kidney from a donor who is known to have received an investigational therapy under another IND/CTA for ischemic/reperfusion injury immediately prior to organ recovery.
  10. Known to human monoclonal antibodies or any of the study drug .
  11. Previous hypersensitivity to basiliximab, Campath-1H or antithymocyte globulin (ATG).
  12. History of within the last five years, except excised squamous or basal cell carcinoma of the skin, or cervical intraepithelial neoplasia.
  13. positive recipients.
  14. surface antigen positive kidney transplant recipients.
  15. Hepatitis B core antibody positive kidney transplant recipients.
  16. virus positive (HCV+) patients who are either untreated or have failed to demonstrate sustained viral remission for more than 12 months after anti-viral treatment.
  17. Presence of infections requiring continued therapy.
  18. Positive screening for active tuberculosis.
  19. Existence of any surgical or medical condition, other than the current transplantation which, in the opinion of the investigator, might significantly alter the distribution, metabolism or excretion of study medication.
  20. Has a positive T- or B-cell cross-match by NIH anti-globulin lymphocytotoxicity method or CDC crossmatch method, if performed.
  21. Has a positive T- or B-cell flow cross-match (over 250 channel shift) AND donor specific anti-HLA antibody (DSA) detected by flow cytometry (Luminex®) based antigen-specific anti-HLA antibody testing (over 4000 MFI) or by similar methodology, if performed.
  22. History or presence of a medical condition or disease that in the investigator's assessment would place the patient at an unacceptable risk for study participation.
  23. Lactating or pregnant woman.
  24. Patient institutionalized by administrative or court order.
  25. HLA or ABO incompatible kidney defined as a positive cytotoxic crossmatch or positive flow cross match.
  26. Patients with known prothrombotic disorder (e.g. homozygous factor V leiden)
  27. History of thrombosis or hypercoagulable state excluding access clotting
  28. History of administration of C1INH containing products or recombinant C1INH within 15 days prior to study entry.
  29. Patient with an abnormal Thromboelastogram.- results must be reported out prior to dosing (Defined by Coagulation Index of >3.0)
  30. Patients on warfarin or other anti-coagulants or anti-, such as Plavix, low molecular weight heparin (Low-dose aspirin prophylaxis allowed) due to a history or thrombotic or embolic events, or at a significantly increased risk for thrombosis due to conditions such as carotid stenosis or prosthetic valves.
  31. Patients with known to treatment with C1INH
  32. Patients with elevated abnormal platelet function (PLT>500,000).
  33. Known or suspected allergy to rabbits and rabbit-derived products. History of immediate hypersensitivity reactions, including anaphylaxis, to C1 esterase inhibitor preparations.
  34. Patients belonging to vulnerable populations: refers to but not limited to children, minors, pregnant women, prisoners, terminally ill patients, comatose, physically and intellectually challenged individuals, institutionalized, visual or hearing impaired, refugees, international research, and educationally disabled healthy volunteers.
  35. Diagnosis of reversible Acute Kidney Injury
Terms in these criteria, in plain language(15)

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.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Postmenopausal

Periods have stopped for good: usually no period for 12 months in a row without another medical reason, sometimes confirmed by a blood test (FSH).

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

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.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

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.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

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.

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.

05

Study design

Phase
Phase 1
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Investigator)
Enrollment
20 participants (estimated)

Study arms

  • Placebo comparator
    Control Group

    Intervention is saline solution placebo (0.9% Sodium Chloride IV to equal volume of investigational arm: intraoperatively, and then every 12 hours x 2 = total of 3 doses)

    Other: Saline Solution

  • Experimental
    rhC1INH

    Intervention is rhC1INH 100 U/kg intraoperative followed by 50 U/kg every 12 hours x 2 = total of 3 doses (200 U/kg)

    Drug: rhC1INH

Interventions

  • C1 esterase inhibitor

    Also known as: ruconest

  • OtherSaline Solution

    saline solution

06

What researchers measure

Primary outcomes

  1. Number of patients that do not meet DGF criteria based on creatinine levels following kidney transplantation from DCD donor who are treated with study drug compared to placebo

    Incidence of delayed graft function in the first 7 days following kidney transplant as defined as the initiation of dialysis in the first 7-days post transplantation and functional DGF as defined as a failure of the serum creatinine to decrease by at least 10% daily on 3 successive days during the first week post transplantation.

    Time frame: over a 12 month period

Secondary outcomes

  1. Incidence of adverse and serious adverse events will be assessed via descriptive statistics method

    The feasibility of different statistical methods to analyze the incidence of adverse and serious adverse events

    Time frame: over a 12 month period

  2. Ascertain whether any unexpected toxicities will occur in this patient population according to the Common Toxicity Criteria for Adverse Events (CTCAE) patient population

    Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

    Time frame: over a 12 month period

  3. Willingness of participation will be evaluated based on number of potential study candidates (approaches) compared to the number of candidates that enroll in the study likely response rates

    Enrollment rate of eligible participants

    Time frame: over a 12 month period

  4. Tolerability following drug administration as measured by blood pressure

    The ability and tolerability to administer the study drug 3 times with appropriate post administration by recording blood pressure in mmHg

    Time frame: over a 12 month period

  5. Tolerability following drug administration as measured by HR (heart rate)

    The ability and tolerability to administer the study drug 3 times with appropriate pre and post administration by recording heart rate as beats per minute

    Time frame: over a 12 month period

  6. Tolerability following drug administration as measured by temperature

    The ability and tolerability to administer the study drug 3 times with appropriate pre and post administration by recording temperature in degrees Fahrenheit

    Time frame: over a 12 month period

  7. Tolerability following drug administration as measured by respiratory rate

    The ability and tolerability to administer the study drug 3 times with appropriate pre and post administration by recording the respiratory rate as breathes per minute

    Time frame: over a 12 month period

  8. Tolerability of drug administration as measured by urinary output

    To assess tolerability, upon administration of the drug, amount of urinary output will be recorded in mL

    Time frame: over a 12 month period

07

Study locations

1 of 1 sites recruiting
  • University of Wisconsin
    Madison, Wisconsin 53792, United States
    Recruiting
    • Luis Fernandez, MD · Contactluis@surgery.wisc.edu · 608-263-9903
    • Luis Fernandez, MD · Principal investigator
08

References and documents

Publications

  • Ricklin D, Hajishengallis G, Yang K, Lambris JD. Complement: a key system for immune surveillance and homeostasis. Nat Immunol. 2010 Sep;11(9):785-97. doi: 10.1038/ni.1923. Epub 2010 Aug 19. PubMed 20720586 ↗
  • Ricklin D, Lambris JD. Complement in immune and inflammatory disorders: pathophysiological mechanisms. J Immunol. 2013 Apr 15;190(8):3831-8. doi: 10.4049/jimmunol.1203487. PubMed 23564577 ↗
  • Zipfel PF, Skerka C. Complement regulators and inhibitory proteins. Nat Rev Immunol. 2009 Oct;9(10):729-40. doi: 10.1038/nri2620. Epub 2009 Sep 4. PubMed 19730437 ↗
  • Blom AM, Villoutreix BO, Dahlback B. Complement inhibitor C4b-binding protein-friend or foe in the innate immune system? Mol Immunol. 2004 Apr;40(18):1333-46. doi: 10.1016/j.molimm.2003.12.002. PubMed 15072852 ↗
  • Jozsi M, Zipfel PF. Factor H family proteins and human diseases. Trends Immunol. 2008 Aug;29(8):380-7. doi: 10.1016/j.it.2008.04.008. Epub 2008 Jul 2. PubMed 18602340 ↗
  • Davis AE 3rd. Biological effects of C1 inhibitor. Drug News Perspect. 2004 Sep;17(7):439-46. doi: 10.1358/dnp.2004.17.7.863703. PubMed 15514703 ↗
  • Eltzschig HK, Eckle T. Ischemia and reperfusion--from mechanism to translation. Nat Med. 2011 Nov 7;17(11):1391-401. doi: 10.1038/nm.2507. PubMed 22064429 ↗
  • Kono H, Rock KL. How dying cells alert the immune system to danger. Nat Rev Immunol. 2008 Apr;8(4):279-89. doi: 10.1038/nri2215. Epub 2008 Mar 14. PubMed 18340345 ↗
  • Friedewald JJ, Rabb H. Inflammatory cells in ischemic acute renal failure. Kidney Int. 2004 Aug;66(2):486-91. doi: 10.1111/j.1523-1755.2004.761_3.x. PubMed 15253694 ↗
  • Diepenhorst GM, van Gulik TM, Hack CE. Complement-mediated ischemia-reperfusion injury: lessons learned from animal and clinical studies. Ann Surg. 2009 Jun;249(6):889-99. doi: 10.1097/SLA.0b013e3181a38f45. PubMed 19474697 ↗
  • Guo RF, Ward PA. Role of C5a in inflammatory responses. Annu Rev Immunol. 2005;23:821-52. doi: 10.1146/annurev.immunol.23.021704.115835. PubMed 15771587 ↗
  • McCaughan JA, O'Rourke DM, Courtney AE. The complement cascade in kidney disease: from sideline to center stage. Am J Kidney Dis. 2013 Sep;62(3):604-14. doi: 10.1053/j.ajkd.2012.12.033. Epub 2013 Mar 13. PubMed 23489674 ↗
  • Gasque P. Complement: a unique innate immune sensor for danger signals. Mol Immunol. 2004 Nov;41(11):1089-98. doi: 10.1016/j.molimm.2004.06.011. PubMed 15476920 ↗
  • Zhou W, Farrar CA, Abe K, Pratt JR, Marsh JE, Wang Y, Stahl GL, Sacks SH. Predominant role for C5b-9 in renal ischemia/reperfusion injury. J Clin Invest. 2000 May;105(10):1363-71. doi: 10.1172/JCI8621. PubMed 10811844 ↗
  • Weiser MR, Williams JP, Moore FD Jr, Kobzik L, Ma M, Hechtman HB, Carroll MC. Reperfusion injury of ischemic skeletal muscle is mediated by natural antibody and complement. J Exp Med. 1996 May 1;183(5):2343-8. doi: 10.1084/jem.183.5.2343. PubMed 8642343 ↗
  • de Vries B, Walter SJ, Peutz-Kootstra CJ, Wolfs TG, van Heurn LW, Buurman WA. The mannose-binding lectin-pathway is involved in complement activation in the course of renal ischemia-reperfusion injury. Am J Pathol. 2004 Nov;165(5):1677-88. doi: 10.1016/S0002-9440(10)63424-4. PubMed 15509537 ↗
  • Moller-Kristensen M, Wang W, Ruseva M, Thiel S, Nielsen S, Takahashi K, Shi L, Ezekowitz A, Jensenius JC, Gadjeva M. Mannan-binding lectin recognizes structures on ischaemic reperfused mouse kidneys and is implicated in tissue injury. Scand J Immunol. 2005 May;61(5):426-34. doi: 10.1111/j.1365-3083.2005.01591.x. PubMed 15882434 ↗
  • Schwaeble WJ, Lynch NJ, Clark JE, Marber M, Samani NJ, Ali YM, Dudler T, Parent B, Lhotta K, Wallis R, Farrar CA, Sacks S, Lee H, Zhang M, Iwaki D, Takahashi M, Fujita T, Tedford CE, Stover CM. Targeting of mannan-binding lectin-associated serine protease-2 confers protection from myocardial and gastrointestinal ischemia/reperfusion injury. Proc Natl Acad Sci U S A. 2011 May 3;108(18):7523-8. doi: 10.1073/pnas.1101748108. Epub 2011 Apr 18. PubMed 21502512 ↗
  • Castellano G, Melchiorre R, Loverre A, Ditonno P, Montinaro V, Rossini M, Divella C, Battaglia M, Lucarelli G, Annunziata G, Palazzo S, Selvaggi FP, Staffieri F, Crovace A, Daha MR, Mannesse M, van Wetering S, Paolo Schena F, Grandaliano G. Therapeutic targeting of classical and lectin pathways of complement protects from ischemia-reperfusion-induced renal damage. Am J Pathol. 2010 Apr;176(4):1648-59. doi: 10.2353/ajpath.2010.090276. Epub 2010 Feb 11. PubMed 20150432 ↗
  • Berger SP, Roos A, Mallat MJ, Fujita T, de Fijter JW, Daha MR. Association between mannose-binding lectin levels and graft survival in kidney transplantation. Am J Transplant. 2005 Jun;5(6):1361-6. doi: 10.1111/j.1600-6143.2005.00841.x. PubMed 15888042 ↗
  • Straatsburg IH, Boermeester MA, Wolbink GJ, van Gulik TM, Gouma DJ, Frederiks WM, Hack CE. Complement activation induced by ischemia-reperfusion in humans: a study in patients undergoing partial hepatectomy. J Hepatol. 2000 May;32(5):783-91. doi: 10.1016/s0168-8278(00)80247-0. PubMed 10845665 ↗
  • Williams JP, Pechet TT, Weiser MR, Reid R, Kobzik L, Moore FD Jr, Carroll MC, Hechtman HB. Intestinal reperfusion injury is mediated by IgM and complement. J Appl Physiol (1985). 1999 Mar;86(3):938-42. doi: 10.1152/jappl.1999.86.3.938. PubMed 10066708 ↗
  • Jordan JE, Montalto MC, Stahl GL. Inhibition of mannose-binding lectin reduces postischemic myocardial reperfusion injury. Circulation. 2001 Sep 18;104(12):1413-8. doi: 10.1161/hc3601.095578. PubMed 11560858 ↗
  • Sacks SH. Complement fragments C3a and C5a: the salt and pepper of the immune response. Eur J Immunol. 2010 Mar;40(3):668-70. doi: 10.1002/eji.201040355. PubMed 20186746 ↗
  • Peng Q, Li K, Smyth LA, Xing G, Wang N, Meader L, Lu B, Sacks SH, Zhou W. C3a and C5a promote renal ischemia-reperfusion injury. J Am Soc Nephrol. 2012 Sep;23(9):1474-85. doi: 10.1681/ASN.2011111072. Epub 2012 Jul 12. PubMed 22797180 ↗
  • de Vries B, Kohl J, Leclercq WK, Wolfs TG, van Bijnen AA, Heeringa P, Buurman WA. Complement factor C5a mediates renal ischemia-reperfusion injury independent from neutrophils. J Immunol. 2003 Apr 1;170(7):3883-9. doi: 10.4049/jimmunol.170.7.3883. PubMed 12646657 ↗
  • Djamali A, Muth BL, Ellis TM, Mohamed M, Fernandez LA, Miller KM, Bellingham JM, Odorico JS, Mezrich JD, Pirsch JD, D'Alessandro TM, Vidyasagar V, Hofmann RM, Torrealba JR, Kaufman DB, Foley DP. Increased C4d in post-reperfusion biopsies and increased donor specific antibodies at one-week post transplant are risk factors for acute rejection in mild to moderately sensitized kidney transplant recipients. Kidney Int. 2013 Jun;83(6):1185-92. doi: 10.1038/ki.2013.44. Epub 2013 Feb 27. PubMed 23447068 ↗
  • Stegall MD, Diwan T, Raghavaiah S, Cornell LD, Burns J, Dean PG, Cosio FG, Gandhi MJ, Kremers W, Gloor JM. Terminal complement inhibition decreases antibody-mediated rejection in sensitized renal transplant recipients. Am J Transplant. 2011 Nov;11(11):2405-13. doi: 10.1111/j.1600-6143.2011.03757.x. Epub 2011 Sep 22. Erratum In: Am J Transplant. 2013 Jan;13(1):241. PubMed 21942930 ↗
  • Lefaucheur C, Loupy A, Hill GS, Andrade J, Nochy D, Antoine C, Gautreau C, Charron D, Glotz D, Suberbielle-Boissel C. Preexisting donor-specific HLA antibodies predict outcome in kidney transplantation. J Am Soc Nephrol. 2010 Aug;21(8):1398-406. doi: 10.1681/ASN.2009101065. Epub 2010 Jul 15. PubMed 20634297 ↗
  • Lerut E, Naesens M, Kuypers DR, Vanrenterghem Y, Van Damme B. Subclinical peritubular capillaritis at 3 months is associated with chronic rejection at 1 year. Transplantation. 2007 Jun 15;83(11):1416-22. doi: 10.1097/01.tp.0000266676.10550.70. PubMed 17565313 ↗
  • Dean PG, Park WD, Cornell LD, Gloor JM, Stegall MD. Intragraft gene expression in positive crossmatch kidney allografts: ongoing inflammation mediates chronic antibody-mediated injury. Am J Transplant. 2012 Jun;12(6):1551-63. doi: 10.1111/j.1600-6143.2011.03964.x. Epub 2012 Feb 15. PubMed 22335458 ↗
  • Andres A, Marcen R, Valdes F, Plumed JS, Sola R, Errasti P, Lauzurica R, Pallardo L, Bustamante J, Amenabar JJ, Plaza JJ, Gomez E, Grinyo JM, Rengel M, Puig JM, Sanz A, Asensio C, Andres I; NI2A Study Group. A randomized trial of basiliximab with three different patterns of cyclosporin A initiation in renal transplant from expanded criteria donors and at high risk of delayed graft function. Clin Transplant. 2009 Jan-Feb;23(1):23-32. doi: 10.1111/j.1399-0012.2008.00891.x. Epub 2008 Sep 16. PubMed 18798851 ↗
  • Reddy KS, Stratta RJ, Alloway RR, Lo A, Hodge EE; PIVOT Study Group. The impact of delayed graft function of the kidney on the pancreas allograft in simultaneous kidney-pancreas transplantation. Transplant Proc. 2004 May;36(4):1078-9. doi: 10.1016/j.transproceed.2004.04.052. PubMed 15194374 ↗
  • Shoskes DA, Cecka JM. Effect of delayed graft function on short- and long-term kidney graft survival. Clin Transpl. 1997:297-303. PubMed 9919413 ↗
  • Sanfilippo F, Vaughn WK, Spees EK, Lucas BA. The detrimental effects of delayed graft function in cadaver donor renal transplantation. Transplantation. 1984 Dec;38(6):643-8. doi: 10.1097/00007890-198412000-00019. PubMed 6390827 ↗
  • Shoskes DA, Cecka JM. Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection. Transplantation. 1998 Dec 27;66(12):1697-701. doi: 10.1097/00007890-199812270-00022. PubMed 9884262 ↗
  • Yokoyama I, Uchida K, Kobayashi T, Tominaga Y, Orihara A, Takagi H. Effect of prolonged delayed graft function on long-term graft outcome in cadaveric kidney transplantation. Clin Transplant. 1994 Apr;8(2 Pt 1):101-6. PubMed 8019017 ↗
  • Rosenthal JT, Danovitch GM, Wilkinson A, Ettenger RB. The high cost of delayed graft function in cadaveric renal transplantation. Transplantation. 1991 May;51(5):1115-8. No abstract available. PubMed 2031264 ↗
  • Matas AJ, Gillingham KJ, Elick BA, Dunn DL, Gruessner RW, Payne WD, Sutherland DE, Najarian JS. Risk factors for prolonged hospitalization after kidney transplants. Clin Transplant. 1997 Aug;11(4):259-64. PubMed 9267712 ↗
  • Floerchinger B, Oberhuber R, Tullius SG. Effects of brain death on organ quality and transplant outcome. Transplant Rev (Orlando). 2012 Apr;26(2):54-9. doi: 10.1016/j.trre.2011.10.001. PubMed 22459036 ↗
  • Danobeitia JS, Sperger JM, Hanson MS, Park EE, Chlebeck PJ, Roenneburg DA, Sears ML, Connor JX, Schwarznau A, Fernandez LA. Early activation of the inflammatory response in the liver of brain-dead non-human primates. J Surg Res. 2012 Aug;176(2):639-48. doi: 10.1016/j.jss.2011.10.042. Epub 2011 Nov 19. PubMed 22440934 ↗
  • van der Hoeven JA, Molema G, Ter Horst GJ, Freund RL, Wiersema J, van Schilfgaarde R, Leuvenink HG, Ploeg RJ. Relationship between duration of brain death and hemodynamic (in)stability on progressive dysfunction and increased immunologic activation of donor kidneys. Kidney Int. 2003 Nov;64(5):1874-82. doi: 10.1046/j.1523-1755.2003.00272.x. PubMed 14531823 ↗
  • Damman J, Schuurs TA, Ploeg RJ, Seelen MA. Complement and renal transplantation: from donor to recipient. Transplantation. 2008 Apr 15;85(7):923-7. doi: 10.1097/TP.0b013e3181683cf5. PubMed 18408568 ↗
  • Pratt JR, Abe K, Miyazaki M, Zhou W, Sacks SH. In situ localization of C3 synthesis in experimental acute renal allograft rejection. Am J Pathol. 2000 Sep;157(3):825-31. doi: 10.1016/S0002-9440(10)64596-8. PubMed 10980122 ↗
  • Damman J, Nijboer WN, Schuurs TA, Leuvenink HG, Morariu AM, Tullius SG, van Goor H, Ploeg RJ, Seelen MA. Local renal complement C3 induction by donor brain death is associated with reduced renal allograft function after transplantation. Nephrol Dial Transplant. 2011 Jul;26(7):2345-54. doi: 10.1093/ndt/gfq717. Epub 2010 Dec 2. PubMed 21127132 ↗
  • Atkinson C, Varela JC, Tomlinson S. Complement-dependent inflammation and injury in a murine model of brain dead donor hearts. Circ Res. 2009 Nov 20;105(11):1094-101. doi: 10.1161/CIRCRESAHA.109.194977. Epub 2009 Oct 8. PubMed 19815824 ↗
  • Damman J, Hoeger S, Boneschansker L, Theruvath A, Waldherr R, Leuvenink HG, Ploeg RJ, Yard BA, Seelen MA. Targeting complement activation in brain-dead donors improves renal function after transplantation. Transpl Immunol. 2011 May;24(4):233-7. doi: 10.1016/j.trim.2011.03.001. Epub 2011 Apr 1. PubMed 21440065 ↗
  • Naesens M, Li L, Ying L, Sansanwal P, Sigdel TK, Hsieh SC, Kambham N, Lerut E, Salvatierra O, Butte AJ, Sarwal MM. Expression of complement components differs between kidney allografts from living and deceased donors. J Am Soc Nephrol. 2009 Aug;20(8):1839-51. doi: 10.1681/ASN.2008111145. Epub 2009 May 14. PubMed 19443638 ↗
  • van Werkhoven MB, Damman J, van Dijk MCRF, Daha MR, de Jong IJ, Leliveld A, Krikke C, Leuvenink HG, van Goor H, van Son WJ, Olinga P, Hillebrands JL, Seelen MAJ. Complement mediated renal inflammation induced by donor brain death: role of renal C5a-C5aR interaction. Am J Transplant. 2013 Apr;13(4):875-882. doi: 10.1111/ajt.12130. Epub 2013 Feb 7. PubMed 23398742 ↗
  • Blogowski W, Dolegowska B, Salata D, Budkowska M, Domanski L, Starzynska T. Clinical analysis of perioperative complement activity during ischemia/reperfusion injury following renal transplantation. Clin J Am Soc Nephrol. 2012 Nov;7(11):1843-51. doi: 10.2215/CJN.02200312. Epub 2012 Aug 16. PubMed 22904122 ↗
  • de Vries DK, van der Pol P, van Anken GE, van Gijlswijk DJ, Damman J, Lindeman JH, Reinders ME, Schaapherder AF, Kooten Cv. Acute but transient release of terminal complement complex after reperfusion in clinical kidney transplantation. Transplantation. 2013 Mar 27;95(6):816-20. doi: 10.1097/TP.0b013e31827e31c9. PubMed 23348894 ↗
  • Davis AE 3rd, Lu F, Mejia P. C1 inhibitor, a multi-functional serine protease inhibitor. Thromb Haemost. 2010 Nov;104(5):886-93. doi: 10.1160/TH10-01-0073. Epub 2010 Aug 30. PubMed 20806108 ↗
  • Frank MM. Recombinant and plasma-purified human c1 inhibitor for the treatment of hereditary angioedema. World Allergy Organ J. 2010 Sep;3(9 Suppl):S29-33. doi: 10.1097/WOX.0b013e3181f1428d. PubMed 23282867 ↗
  • Curci C, Castellano G, Stasi A, Divella C, Loverre A, Gigante M, Simone S, Cariello M, Montinaro V, Lucarelli G, Ditonno P, Battaglia M, Crovace A, Staffieri F, Oortwijn B, van Amersfoort E, Gesualdo L, Grandaliano G. Endothelial-to-mesenchymal transition and renal fibrosis in ischaemia/reperfusion injury are mediated by complement anaphylatoxins and Akt pathway. Nephrol Dial Transplant. 2014 Apr;29(4):799-808. doi: 10.1093/ndt/gft516. Epub 2014 Jan 23. PubMed 24463188 ↗
  • Tillou X, Poirier N, Le Bas-Bernardet S, Hervouet J, Minault D, Renaudin K, Vistoli F, Karam G, Daha M, Soulillou JP, Blancho G. Recombinant human C1-inhibitor prevents acute antibody-mediated rejection in alloimmunized baboons. Kidney Int. 2010 Jul;78(2):152-9. doi: 10.1038/ki.2010.75. Epub 2010 Mar 24. PubMed 20336054 ↗
  • Sommer W, Tudorache I, Kuhn C, Avsar M, Salman J, Ius F, Gras C, Weber P, Welte T, Gottlieb J, Haverich A, Warnecke G. C1-esterase-inhibitor for primary graft dysfunction in lung transplantation. Transplantation. 2014 Jun 15;97(11):1185-91. doi: 10.1097/TP.0000000000000034. PubMed 24573112 ↗
  • Feldman HI, Gayner R, Berlin JA, Roth DA, Silibovsky R, Kushner S, Brayman KL, Burns JE, Kobrin SM, Friedman AL, Grossman RA. Delayed function reduces renal allograft survival independent of acute rejection. Nephrol Dial Transplant. 1996 Jul;11(7):1306-13. PubMed 8672027 ↗
  • Westendorp WH, Leuvenink HG, Ploeg RJ. Brain death induced renal injury. Curr Opin Organ Transplant. 2011 Apr;16(2):151-6. doi: 10.1097/MOT.0b013e328344a5dc. PubMed 21415817 ↗
  • Kim IK, Bedi DS, Denecke C, Ge X, Tullius SG. Impact of innate and adaptive immunity on rejection and tolerance. Transplantation. 2008 Oct 15;86(7):889-94. doi: 10.1097/TP.0b013e318186ac4a. PubMed 18852649 ↗
  • Damman J, Daha MR, van Son WJ, Leuvenink HG, Ploeg RJ, Seelen MA. Crosstalk between complement and Toll-like receptor activation in relation to donor brain death and renal ischemia-reperfusion injury. Am J Transplant. 2011 Apr;11(4):660-9. doi: 10.1111/j.1600-6143.2011.03475.x. PubMed 21446970 ↗
  • Asgari E, Zhou W, Sacks S. Complement in organ transplantation. Curr Opin Organ Transplant. 2010 Aug;15(4):486-91. doi: 10.1097/MOT.0b013e32833b9cb7. PubMed 20631616 ↗
  • Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, Port FK, Sung RS. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009 Jul 27;88(2):231-6. doi: 10.1097/TP.0b013e3181ac620b. PubMed 19623019 ↗
  • Merion RM, Ashby VB, Wolfe RA, Distant DA, Hulbert-Shearon TE, Metzger RA, Ojo AO, Port FK. Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA. 2005 Dec 7;294(21):2726-33. doi: 10.1001/jama.294.21.2726. PubMed 16333008 ↗
  • Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, Halloran PF, Baldwin W, Banfi G, Collins AB, Cosio F, David DS, Drachenberg C, Einecke G, Fogo AB, Gibson IW, Glotz D, Iskandar SS, Kraus E, Lerut E, Mannon RB, Mihatsch M, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Roberts I, Seron D, Smith RN, Valente M. Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant. 2008 Apr;8(4):753-60. doi: 10.1111/j.1600-6143.2008.02159.x. Epub 2008 Feb 19. PubMed 18294345 ↗
  • Kaminska D, Koscielska-Kasprzak K, Drulis-Fajdasz D, Halon A, Polak W, Chudoba P, Janczak D, Mazanowska O, Patrzalek D, Klinger M. Kidney ischemic injury genes expressed after donor brain death are predictive for the outcome of kidney transplantation. Transplant Proc. 2011 Oct;43(8):2891-4. doi: 10.1016/j.transproceed.2011.08.062. PubMed 21996181 ↗
  • Parikh CR, Jani A, Mishra J, Ma Q, Kelly C, Barasch J, Edelstein CL, Devarajan P. Urine NGAL and IL-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant. 2006 Jul;6(7):1639-45. doi: 10.1111/j.1600-6143.2006.01352.x. PubMed 16827865 ↗
  • Waikar SS, Liu KD, Chertow GM. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol. 2008 May;3(3):844-61. doi: 10.2215/CJN.05191107. Epub 2008 Mar 12. PubMed 18337550 ↗
  • Damman J, Kok JL, Snieder H, Leuvenink HG, van Goor H, Hillebrands JL, van Dijk MC, Hepkema BG, Reznichenko A, van den Born J, de Borst MH, Bakker SJ, Navis GJ, Ploeg RJ, Seelen MA. Lectin complement pathway gene profile of the donor and recipient does not influence graft outcome after kidney transplantation. Mol Immunol. 2012 Feb;50(1-2):1-8. doi: 10.1016/j.molimm.2011.11.009. Epub 2011 Dec 15. PubMed 22173059 ↗
  • Heijnen BH, Straatsburg IH, Padilla ND, Van Mierlo GJ, Hack CE, Van Gulik TM. Inhibition of classical complement activation attenuates liver ischaemia and reperfusion injury in a rat model. Clin Exp Immunol. 2006 Jan;143(1):15-23. doi: 10.1111/j.1365-2249.2005.02958.x. PubMed 16367929 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Dec 14, 2020, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03791476
Responsible party
Sponsor
First posted
Jan 2, 2019
Start date
Jun 21, 2019
Primary completion
Jan 2022 (estimated)
Completion
Jan 2022 (estimated)
Last update
Dec 14, 2020

Study contacts

Luis Fernandez, MD
Contact
luis@surgery.wisc.edu
608-263-9903
Luis Fernandez
principal investigator · University of Wisconsin, Madison

Oversight

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

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Studies of the drug tested here: Conestat alfa

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