- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02544113
A Randomized Controlled Clinical Trial of Thymoglobulin® After Liver Transplantation
A Randomized Controlled Clinical Trial of Thymoglobulin® and Extended Delay of Calcineurin Inhibitor Therapy for Renal Protection After Liver Transplantation. A Multi-Center Study
This is a 24-month, Phase II, multi-center, two-arm, randomized controlled study of adult patients receiving a single organ liver transplant from a deceased donor; the purpose being to determine the efficacy of Thymoglobulin® induction and delayed initiation of CNI in the long-term preservation of renal function after liver transplantation. This study is based on the outcomes of an earlier phase 1 pilot study which was performed at the Cleveland Clinic.
This study will be conducted at 3 centers, with 110 subjects randomized 1:1 into two groups: Group 1 will receive Thymoglobulin® induction, (4.5 mg/Kg, in 3 doses of 1.5 mg/Kg/dose) with delayed initiation of CNI to begin on Day 10 post LT. Group 2 will receive early CNI initiation (to be started no later than Day 2 post LT), and no Thymoglobulin® induction (or any other antibody).
All subjects will also receive a maintenance immunosuppressive regimen consisting of corticosteroids and mycophenolate mofetil (MMF) according to standard of practice in orthotopic liver transplantation (OLT).
Subjects will be consented pre-transplant. Participation may last up to 12 months post OLT. There are 15 study-related visits which will be completed during standard of care (SOC) visits.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Functional recovery of renal function from acute renal failure occurs in 75% of patients at approximately 14 days after onset of the disease. In liver transplantation, intraoperative hemodynamic insults typically lead to acute renal failure which may be further worsened by exposure to CNI therapy in the early postoperative period. In practice, patients who demonstrate early evidence of acute renal failure often have their CNI therapy delayed for 4-5 days. This duration of CNI delay is too short to have any salutary effect on the course or severity of acute kidney injury as less than 20% of patients experience any functional recovery by day 5.
Thymoglobulin® (Sanofi, Cambridge, MA) is a polyclonal immunosuppressive agent that is derived from rabbits immunized with pediatric thymocytes. It contains antibodies to a wide variety of T-cell antigens and major histocompatibility complex (MHC) antigens and is approved for the treatment of kidney rejection by the FDA. Thymoglobulin® has been shown to be a safe and efficacious induction therapy that permits delayed exposure to CNI therapy while preventing the occurrence of acute rejection in kidney transplantation. The investigators hypothesize that any perioperative insult leading to AKI in OLT recipients is unlikely to be beneficially impacted by a short delay of CNI introduction. Further hypothesized is that avoidance of CNI for 10 days will have a beneficial effect on the course and severity of perioperative AKI. Since perioperative AKI is a potent risk factor for chronic kidney disease (CKD) in the late post-transplant period, also hypothesized is that minimizing the risk and severity of AKI with prolonged delayed exposure to CNI will have a beneficial effect on renal function late after liver transplantation.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Florida
-
Weston, Florida, United States, 33331
- Cleveland Clinic Florida
-
-
Ohio
-
Cincinnati, Ohio, United States
- University of Cincinnati College of Medicine
-
Cleveland, Ohio, United States, 44195
- Cleveland Clinic (Main Campus)
-
-
Wisconsin
-
Milwaukee, Wisconsin, United States, 53226
- Medical College of Wisconsin
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients undergoing deceased donor solitary 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 OLT, (must be within the Milan Criteria)
- Hepatitis C, positive or negative, patients
Exclusion Criteria:
- Prior kidney transplantation
- Congenital or iatrogenic absence of one kidney
- Subjects on renal replacement therapy at the time of OLT
- MELD score >34
- HIV positive patient
- Patient with current severe systemic infection
- History of bacterial peritonitis within 30 days prior to OLT
- Active infection or recent infection within 30 days prior to OLT
- Use of a calcineurin inhibitor continuously for more than 90 days within the past 6 months
- History of hypersensitivity to Thymoglobulin®, rabbits or tacrolimus
- Pregnant and/or nursing (lactating) females.
- Women of childbearing age who are unwilling to use effective contraception during the duration of the study, and for 30 days after study participation and/or last dose of Study Drug.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Thymo
Subjects randomized to the (Delay CNI) group will be treated with Thymoglobulin® (total dose of 4.5 mg/kg) administered in three doses; (each dose being 1.5 mg/kg - administered Day 0 [after transplant], Day 2, and Day 4 post transplant), along with CNI delay for 10 days.
CNI will be initiated on postoperative (post-transplant) Day 10.
Subjects will also receive a maintenance immunosuppression regimen of corticosteroids and MMF in accordance with the standard practice at each clinical center.
|
Treatment with thymoglobulin and delayed CNI post OLT
Other Names:
|
Placebo Comparator: Control
Subjects randomized to the (Early CNI) group (Control group) will receive no antibody therapy for induction and will start CNI therapy on postoperative (post-transplant) Day 2. Subjects will also receive a maintenance immunosuppression regimen of corticosteroids and MMF in accordance with the standard practice at each clinical center.
|
Normal transplant immunosuppression
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The Incidence of Acute Kidney Injury (AKI) as Assessed by Change in Serum Creatinine From Baseline to 30 Days Post-transplant
Time Frame: 30 days post-transplant
|
Change in serum creatinine from baseline to 30 days post-transplant.
Higher values are associated with worse outcomes, and values greater than 0.3 mg/dL are suggestive of acute kidney injury.
|
30 days post-transplant
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants Experiencing Acute Cellular Rejection
Time Frame: 30 days post OLT
|
The number of participants experiencing acute cellular rejection, as determined by biopsy.
|
30 days post OLT
|
Graft Survival
Time Frame: 6 months post OLT
|
Number of participants who did not require retransplantation
|
6 months post OLT
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Bijan Eghtesad, The Cleveland Clinic
Publications and helpful links
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 15-943
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
Clinical Trials on Liver Failure
-
Institute of Liver and Biliary Sciences, IndiaCompletedAcute Liver FailureIndia
-
Beijing Continent Pharmaceutical Co, Ltd.RecruitingAcute-On-Chronic Liver Failure | Acute Liver FailureChina
-
Institute of Liver and Biliary Sciences, IndiaCompletedAcute Liver Failure | Acute on Chronic Liver FailureIndia
-
Tianjin Weikai Bioeng., Ltd.Tianjin Nankai HospitalUnknownLiver Failure, Acute on ChronicChina
-
HLB Cell Co., Ltd.UnknownAcute-On-Chronic Liver Failure | Acute Liver FailureKorea, Republic of
-
Nanfang Hospital of Southern Medical UniversityCompletedLiver Injury | Liver Failure, Acute on Chronic
-
Third Affiliated Hospital, Sun Yat-Sen UniversityWithdrawnAcute-On-Chronic Liver Failure | Acute Liver FailureChina
-
RenJi HospitalNot yet recruiting
-
RenJi HospitalShanghai Institute of Biochemistry and Cell BiologyNot yet recruitingAcute-On-Chronic Liver Failure | Chronic Liver Failure
-
Institute of Liver and Biliary Sciences, IndiaRecruitingAcute on Chronic Liver FailureIndia
Clinical Trials on Thymoglobulin
-
University of California, Los AngelesGenzyme, a Sanofi CompanyWithdrawnLung TransplantUnited States
-
M.D. Anderson Cancer CenterGenzyme, a Sanofi CompanyTerminated
-
Institut Paoli-CalmettesSanofiNot yet recruiting
-
Washington University School of MedicineGenzyme, a Sanofi CompanyCompletedRelapsed Or Refractory Multiple MyelomaUnited States
-
University Hospital, LilleErasme University HospitalCompletedRenal TransplantationFrance
-
University of CincinnatiGenzyme, a Sanofi CompanyCompletedRenal Transplant Rejection | Transplants and ImplantsUnited States
-
Peking University People's HospitalCompletedLeukemia, GVHD, ATG, TransplantationChina
-
University Hospital, BrestUnknown
-
Hospices Civils de LyonRecruitingHematopoietic Stem Cell Transplantation-Associated Thrombotic MicroangiopathyFrance
-
Shanghai General Hospital, Shanghai Jiao Tong University...UnknownLymphoblastic LymphomaChina