- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00867386
Desensitization for Highly Sensitized Recipients of Pancreas Transplantation
Study Overview
Status
Detailed Description
Please note that this study is observational. The treatment of each patient will be at the discretion of the care physician. The study investigators will ONLY be performing data collection and analysis.
Post transplant all patients will receive one additional cycle of plasma exchange with a moderate dose of Intravenous Immunoglobulin (IVIg) (0.4 mg/Kg). Antibody titers will be monitoring prior to plasma exchange and immediately following the treatment. At this point, since donor antigens are known, only antibodies to these antigens will be tested to minimize cost. We anticipate that in some patients, especially if the original titer of donor-specific antibody (DSA) was high (> 1:128), a rise in DSA will be observed following transplant. If indeed DSA will be present, additional monitoring will be initiated and the patient will be treated further with plasma exchange/IVIg cycles, with antibody monitoring before and immediately after each cycle. If no DSA are detected, patients will be monitoring on a every other day schedule for the first week; weekly for the next 3 weeks and monthly up to 6 months post transplant. Additional testing will be performed in the event of any clinical evidence of graft dysfunction, or following sever infection events.
Patient will be followed to 12 month post transplant or until one of the end points is reached:
- pancreas graft failure: defined by return of hyperglycemia and resume of insulin therapy;
- patient death due to all causes with functioning graft
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Illinois
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Chicago, Illinois, United States, 60611
- Northwestern University
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Pancreas transplant recipients with elevated panel reactive antibody levels of >50% and who have received desensitization treatment and subsequently receive their transplantation at Northwestern Memorial Hospital (NMH).
Exclusion Criteria:
- No Exclusion criteria exist.
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Success of surgical engraftment.
Time Frame: Post-operative day 1
|
This is measured by standard blood flow perfusion scan.
Adequate blood flow is demonstrated by appropriate radioactive tracer uptake by the pancreas allograft.
Lack of blood flow will prompt immediate surgical intervention.
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Post-operative day 1
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Track the improvement of glycemic control.
Time Frame: Standard-of-care labs throughout duration of study
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Standard of care laboratory values measured routinely include: fasting and post-prandial glucose determination, serum C-peptide levels, improvement of Hemoglobin (A1C) levels post-transplant.
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Standard-of-care labs throughout duration of study
|
Rejection free graft survival.
Time Frame: 12 Month follow-up from baseline
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Serum amylase & lipase measured.
Rising levels/aberrant glycemic control may indicate allograft rejection.
Treatment - pancreas allograft rejection: 1) diagnosed by pancreas allograft biopsy; 2) if rejection, staining for C4d, repeat to DSA to determine rejection (acute antibody meditated humoral vs. acute cellular); 3) acute humoral rejection treated w/plasma exchange, then by Intravenous Immunoglobulin (IVIg) (0.5 gm/kg) every other day, daily polyclonal anti-thymocyte globulin (ATG) at 1.25 mg/kg.
Treatment duration based on clinical response.
Baseline immunosuppressive medications maintained during treatment.
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12 Month follow-up from baseline
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Patient and graft survival.
Time Frame: At 12 Month follow-up
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Patient and graft survival will be calculated at this time.
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At 12 Month follow-up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Tracking infection risks
Time Frame: Standard of care benchmarks through 12 months
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Screening for viral infections will be performed according to standard of care protocol.
Asymptomatic or symptomatic Cytomegalovirus (CMV) viremia will be treated in consultation with Transplant Infectious Diseases Services.
Testing for bacterial and fungal infections will be guided by clinical suspicion.
Active infection will again be treated in consultation with the Transplant Infectious Diseases Service.
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Standard of care benchmarks through 12 months
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Bleeding complications
Time Frame: At 12 Months follow-up time points
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Though increased risks for bleeding have been associated with repeated plasma exchanges that deplete clotting factors, review to evaluate whether the limited number of plasma exchanges used in the standard of care protocols will show a minimal increase of risks for bleeding.
At 12 Month follow-up time points, the number of bleeding episodes, their temporal relation to plasma exchange, and frequency of requirement for factor replacement will be analyzed.
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At 12 Months follow-up time points
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Reversal or halting of diabetic complications
Time Frame: 0, 6, 12, 18, 24 Months
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For diabetic nephropathy, serum creatinine levels and urine microalbuminuria will be measured.
the use of ACE inhibitors, angiotensin receptor blocker, or aldosterone receptor blocker will be noted.
For diabetic retinopathy, patients will be referred to an ophthalmologist at the 12 and 24 Months time points to measure diabetic retinal changes based on the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system.
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0, 6, 12, 18, 24 Months
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Xunrong Luo, MD, PhD, Northwestern University
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- STU 14940
- CNV0058087 (Other Identifier: Office for Sponsored Research, Northwestern University)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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