Reparixin in Prevention of Delayed Graft Function After Kidney Transplantation

Randomized, Double-blind, Placebo-controlled, Parallel-group Pilot Study to Assess Efficacy, Safety and Pharmacokinetics of 2 Schedules of Reparixin in the Prevention of Delayed Graft Function After Kidney Transplant in High Risk Patients

The chemokine CXCL8 plays a key role in the recruitment and activation of polymorphonuclear neutrophils in post-ischemia reperfusion injury after solid organ transplantation. Reparixin is a novel, specific inhibitor of CXCL8. This study is configured to explore the safety and efficacy of reparixin in preventing the delayed graft function (DGF) after kidney transplantation.

Study Overview

• Status: Completed
• Conditions: Kidney Diseases; Ischemia-Reperfusion Injury
• Intervention / Treatment: Drug: Reparixin continuous infusion; Drug: reparixin intermittent infusion; Other: placebo infusion

Detailed Description

Delayed graft function (DGF) is the most common allograft complication in the immediate kidney post-transplant period, affecting 25-35% of all patients who receive a cadaver graft, but rates up to 50% have been reported, especially in recipients of kidneys from marginal donors. It is an important clinical complication as it requires dialysis, prolongs hospitalisation, raises the cost of transplantation, and makes more difficult the management of immunosuppressive therapy. Although the effects of DGF on long-term graft function are still debated, there is overall increasing evidence that DGF reduces long-term graft survival. Moreover, given the well documented impact of acute rejection on long-term graft survival, it is conceivable that DGF and acute rejection synergize in negatively influencing long-term graft survival. Kidney reperfusion, after long cold ischemia period, is associated with an inflammatory reaction characterized by massive polymorphonuclear leukocyte (PMN) infiltration both at the glomerular and tubular levels. The importance of CXCL8 in recruiting PMN in kidney tissue during the ischemic time and after reperfusion has been clearly documented.

The efficacy of reparixin in preventing PMN infiltration and tissue damage in rat models of kidney transplantation and lung transplantation, as well as the safety shown in human phase 1 studies, provide the rationale for a clinical study aimed at evaluating the effect of reparixin in preventing DGF after kidney transplantation

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Phase 2

Contacts and Locations

Study Locations

• France
  • Montpellier, France, 34295 Cedex 5
    • Service de Nephrologie et Transplantation, Hopital Lapeyronie, Centre Hospitalier Universitaire Montpellier
  • Paris, France, 75743 Cedex 15
    • Service de Transplantation et Soins Intensifs Nephrologiques, Hopital Necker
• Italy
  • Bergamo, Italy, 24128
    • Divisione di Nefrologia e Dialisi, Ospedali Riuniti di Bergamo
  • Brescia, Italy, 25123
    • Divisione di Nefrologia e Dialisi, Azienda Ospedaliera Spedali Civili di Brescia
  • Padova, Italy, 35128
    • Università degli Studi di Padova, Clinica Chirurgica III
• Spain
  • Barcelona, Spain, 08036
    • Renal Transplant Unit, Hopital Clinic i Provincial de Barcelona
  • Barcelona, Spain, 08907
    • Division of Nephrology, Institut Catala de la Salut, Ciutat Sanitaria i Universitaria de Bellvitge
• United States
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
      • Transplant Center, University of Minnesota Medical School
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19102
      • Division of Transplantation, Drexel University College of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 63 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male and female patients accepted and listed for renal transplantation due to end stage renal disease (ESRD)
• Planned isolated single kidney transplant from a non-living donor with brain death
• Recipients of a kidney maintained in cold storage
• Recipients at risk of developing DGF
• Planned induction with steroids + mycophenolate mofetil (MMF) or mycophenolic acid + biological induction
• Patient willing and able to comply with the protocol procedures for the duration of the study, including scheduled follow-up visits and examinations
• Patient given written informed consent, prior to any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to their future medical care

Exclusion Criteria:

• Recipients of an intended multiple organ transplant
• Recipients of a kidney from a living donor
• Recipients of a kidney from a non-heart beating donor
• Recipients of double kidney transplant
• Re-transplant >2
• Recipients of a kidney maintained by pulsatile machine perfusion
• Concurrent sepsis
• Recipients with hepatic dysfunction at the time of transplant
• Clinical contraindications to central line access, or arteriovenous fistula, if any, not suitable for infusion of investigational product
• Hypersensitivity to non steroidal anti-inflammatory drugs (NSAIDs)
• Patients simultaneously participating in any other clinical trials involving an investigational drug not yet authorized for use in kidney transplant
• Pregnant or breast-feeding women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: reparixin group - continuous infusion; Continuous iv infusion into a (high flow) central vein (or through an arterio-venous fistula) by an infusion pump. A dose of 2.772 mg/kg/h was administered for12 hours.	Drug: Reparixin continuous infusion; The Investigational Product was administered as an intravenous infusion into a (high flow) central vein or through an arterio-venous fistula, by an infusion pump adequate to provide reliable infusion rates, as per treatment schedule. Total infusion volume did not exceed 500 mL/24 hours. A dose of 2.772 mg/kg body weight/hour was to be administered for 12 hours. Placebo was volume/schedule matched saline.; Other Names: REP
Experimental: reparixin group - intermittent infusion; Intermittent iv infusion into a (high flow) central vein (or through an arterio-venous fistula) by an infusion pump. A dose of 2.244 mg/kg was administered over a 30-minute period, followed by a 1.5-hour interval. Twelve doses were administered over a total period of 22.5 hours.	Drug: reparixin intermittent infusion; A dose of 2.244 mg/kg body weight was to be administered over a 30-minute period, followed by a 1.5-hour interval. Twelve doses were to be administered over a total period of 22.5 hours. Placebo was volume/schedule matched saline.; Other Names: REP
Placebo Comparator: placebo infusion; Continuous/intermittent iv infusion of a volume/schedule matched saline into a (high flow) central vein (or through an arterio-venous fistula) by an infusion pump.	Other: placebo infusion; placebo was volume/schedule matched saline

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Creatinine Clearance (CrCl) in the Immediate Post-transplant Period	CrCl was determined by two 60 minute urine collections, during the time intervals 1-3 and 10-12 hours of allograft reperfusion. Blood was withdrawn at the midpoint of each urine collection. CrCl at each timepoint was calculated according to the formula: creatinine clearance (mL/minutes) = urine creatinine (mmol/L) x urine volume (mL) / serum creatinine (mmol/L) x time of collection (minutes) An average was to be calculated from the two 60 minute values in each interval.	1-3 and 10-12 hours post allograft reperfusion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Renal Function Tests - Serum Creatinine	Serum creatinine (SrCr) was measured daily from Day 1 up to 7 days post-transplant or up to hospital discharge, whichever occurred earlier; in patients undergoing dialysis, SrCr values were measured immediately before dialysis.	daily up to day 7 post-transplant or hospital discharge
Renal Function Tests - Calculated Glomerular Filtration Rate	Calculated glomerular filtration rate (GFR) was measured daily from Day 1 up to 7 days post-transplant or up to hospital discharge, whichever occurred earlier; in patients undergoing dialysis, SrCr values were measured immediately before dialysis	from Day 1 up to 7 days post-transplant or up to hospital discharge
Renal Function Tests - Urine Output	Urine output, measured in the interval from transplant to 8:00 of Day 1, and then daily from Day 2 up to 7 days post-transplant or up to hospital discharge, whichever occurred earlier	from Day 1 up to 7 days post-transplant or up to hospital discharge
Number of Patients Requiring Dialysis Within 7 Days Post-transplant	The number of patients who required dialysis within 7 days post-transplant was evaluated.	up to day 7 post-transplant
Number of Days on Dialysis Before Resuming Kidney Function	the number of days on dialysis before resuming kidney function was evaluated.	up to Day 7 post-transplant
Number of Patients With Immediate, Slow and Delayed Graft Function	The number of patients who required dialysis within 7 days post-transplant was evaluated. Immediate graft function: SrCr ≤3 mg/dL on post operative day 5) Slow graft function: SrCr >3 mg/dL dL on post operative day 5, no need of dialysis) Delayed graft function: Dialysis needed in the first week)	day 5 post-transplant
Duration of Hospital Stay	The mean duration of hospital stay was evaluated.	first 30 days post-transplant
Mortality	Mortality in the first 30 days post-transplant was evaluated.	first 30 days post-transplant
Serum Creatinine at Month 1, Month 6 and Month 12	Serum creatinine (SrCr) was measured at Month 1, Month 6 and Month 12.	at Month 1, Month 6 and Month 12
Calculated Serum Creatinine Clearance at Month 1, Month 6 and Month 12	Creatinine clearance (CrCl) is the volume of blood plasma cleared of creatinine per unit time. It is a rapid and cost-effective method for the measurement of renal function.	at Month 1, Month 6 and Month 12
Acute Rejection Episodes at Month 6 and Between Month 6 and Month 12	Acute rejection defined as an increase in serum creatinine level after exclusion of other causes of graft dysfunction, accompanied by a sudden decline in glomerular filtration rate and renal function and well-established diagnostic features on kidney allograft biopsy which can be either antibody-mediated and/or T cell-mediated and can occur at any time after transplant.	at Month 6 and between Month 6 and Month 12
Patient Survival Rate	Numbers of patients alive, dead, and lost to follow up are reported.	at Month 1, Month 6 and Month 12
Graft Survival Rate	Graft failure was defined as the failure of graft function for any reason, ultimately requiring renal replacement therapy and/or retransplantation (United States Renal Data System [USRDS] 2017.	at Month 1, Month 6 and Month 12

Collaborators and Investigators

• Sponsor: Dompé Farmaceutici S.p.A
• Investigators: Principal Investigator: Giuseppe Remuzzi, MD, A.O. Ospedale Papa Giovanni XXIII

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2005
• Primary Completion (Actual): May 1, 2008
• Study Completion (Actual): June 1, 2008

Study Registration Dates

• First Submitted: November 2, 2005
• First Submitted That Met QC Criteria: November 2, 2005
• First Posted (Estimated): November 3, 2005

Study Record Updates

• Last Update Posted (Actual): January 10, 2024
• Last Update Submitted That Met QC Criteria: January 8, 2024
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Keywords: Survival; Kidney transplantation; Reperfusion Injury
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Urologic Diseases; Postoperative Complications; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Kidney Diseases; Ischemia; Reperfusion Injury; Delayed Graft Function
• Other Study ID Numbers: REP0204