- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02515708
Pilot Study to Assess Safety and Feasibility of Normothermic Machine Preservation In Human Liver Transplantation
A Phase I Pilot Study to Assess Safety and Feasibility of Normothermic Machine Preservation In Human Liver Transplantation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The shortage of donor organs leads to the use of marginal donors including donors after cardiac death. Normothermic machine perfusion (NMP) preservation is a promising method to decrease their high risk of complication compared to the standard cold storage (CS). The aim of this project is to assess safety and feasibility of NMP in human liver transplantation.
This will be a single center prospective cohort pilot study. Thirty-two livers that have acceptable quality for transplantation will be preserved with NMP in 2-18 hours after cross clamp and cold flush. The liver grafts at NMP will be at physiological temperature and have oxygen and nutrient supply with continuous perfusion. The transplantation and post-transplant care will follow the standard of care. The follow-up period is 12 months after transplantation. The primary end point will be the rate of post-transplant Early Allograft Dysfunction (EAD), while the secondary end points will be: primary non function (PNF) rate, 1 and 6 months patient and graft survival, peak liver function tests in the first 7 days after transplantation, intraoperative hepatic arterial and portal flow measurement, rate and magnitude of post-reperfusion syndrome, surgical outcomes (operative time, transfusion requirement etc.), rate of post-transplant kidney failure, assessment of histological ischemia reperfusion (liver and bile duct), rate of vascular complications, rate of biliary complications, hospital and ICU length of stay, rejection rate, infection rate, the ability to predict function based on "on-pump" viability markers, and the incidence of adverse effect (AE).
The outcome will be compared to a control group of 100 historical patients (matched with a 1:4 ratio) transplanted in our program in the past 10 years (liver preserved using CS). Control subjects will be matched using donor and recipient age, Model for End-Stage Liver Disease (MELD) score, cold ischemia time, donor risk index and presence of steatosis.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Ohio
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Cleveland, Ohio, United States, 44195
- Cleveland Clinic
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients undergoing primary liver transplantation
- Age 18-75 years at the time of transplantation
- Willingness and ability to comply with the study procedures
- Signed Informed Consent Form
- For patients with hepatocellular carcinoma as indication for Orthoptic Liver Transplantation (OLT), tumor must be within Milan Criteria or down-staged to Milan Criteria.
Exclusion Criteria:
Recipient Exclusion Criteria:
- History of prior solid organ transplantation
- Patient on a respiratory and/or cardiocirculatory support at the time of transplant
- MELD score >35
- HIV positive patient
- Patient with current severe systemic infection
- Multiorgan transplant
Donor Exclusion Criteria:
- Donor age <14 or >70 years
- Liver steatosis (on visual estimate or on liver biopsy) > 30%
- Donors with Grade 2-3 traumatic liver laceration
- Partial grafts (living donors and split liver donors)
- Liver in which the investigator is unwilling or unable (for logistical reasons) to perform normothermic machine perfusion (NMP) preservation
- Inability to NMP perfuse the liver within 4 hours after cross clamp
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Normothermic Liver perfusion
This group has the liver grafts preserved using the Normothermic Liver perfusion Device.
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The liver grafts will be preserved at physiological temperature and have continuous perfusion with oxygen and nutrient supply in the ex vivo organ preservation phase.
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Other: Normothermic Machine Perfusion (single pump)
This group has the liver grafts preserved using a single-pump variant of the Normothermic Liver perfusion Device.
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The liver grafts will be preserved at physiological temperature and have continuous perfusion with oxygen and nutrient supply in the ex vivo organ preservation phase.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
the rate of Early Allograft Dysfunction post-transplantation in Normothermically Machine Perfused (NMP) livers
Time Frame: 7 days post-transplantation
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The presence of at least one of the following at post-transplant 7 days: serum bilirubin >= 10 mg/dL, international normalized ratio (INF) >= 1.6; and/or aspartate aminotransferase (AST) > 2000 U/L at any time in the first 7 post-transplant days (POD)
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7 days post-transplantation
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
primary non-function rate
Time Frame: in the first 10 days post-transplantation
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in the first 10 days post-transplantation
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graft survival
Time Frame: 6 months post-transplantation
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The allograft will be considered lost if a patient has a liver re-transplant or in the event of patient death.
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6 months post-transplantation
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peak liver function tests in the first 7 days post-transplantation
Time Frame: in the first 7 days post-transplantation
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in the first 7 days post-transplantation
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intraoperative flow measurement
Time Frame: intraoperative
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Flows will be measured with a transit time flowmeter (VeriQ system, MediStim A/S, Oslo, Norway) after graft reperfusion.
The following parameters will be recorded as per our standard practice during liver transplantation: portal venous flow, hepatic artery flow, and hepatic artery flow after temporary portal vein occlusion.
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intraoperative
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post reperfusion syndrome (composite)
Time Frame: in the first 7 days post-transplantation
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rate and magnitude
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in the first 7 days post-transplantation
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surgical outcomes (composite)
Time Frame: intraoperative
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operative time, transfusion requirement
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intraoperative
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rate of post-transplant kidney failure
Time Frame: in the 1, 3, 6 ,9 months post-transplantation
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in the 1, 3, 6 ,9 months post-transplantation
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histology of liver parenchyma
Time Frame: On the day of transplantation
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On the day of transplantation
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vascular complications rate
Time Frame: in the first day post-transplantation
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in the first day post-transplantation
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biliary complications rate
Time Frame: 6 months post-transplantation
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6 months post-transplantation
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hospital and ICU length of stay (composite)
Time Frame: 6 months post-transplantation
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6 months post-transplantation
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rejection rate
Time Frame: 6 months post-transplantation
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6 months post-transplantation
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opportunistic viral infection rate
Time Frame: 6 months post-transplantation
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6 months post-transplantation
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patient survival
Time Frame: 6 months post-transplantation
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6 months post-transplantation
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histology of bile duct
Time Frame: On the day of transplantation
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On the day of transplantation
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 15-549
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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