- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02911714
Contrast-Enhanced Ultrasound for Kidney Transplant
A Pilot Study to Develop Contrast-Enhanced Ultrasound for Kidney Transplant
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD) given improved quality of life, longer survival and lower costs compared with chronic dialysis. Despite these long-term benefits, the first year post-transplant is a critical period that influences health care costs for transplantation and long-term patient and allograft survival. The two most common complications in the first year are delayed graft function (DGF), which affects nearly 25% of deceased-donor transplants, and acute allograft rejection, which affects nearly 10% of all transplants (deceased and living donor). DGF is most commonly caused by severe ischemia-reperfusion injury at transplantation and is a known risk factor for acute rejection and premature failure. Driven by an ever-growing transplant waiting list and limited organs, efforts to utilize higher-risk kidneys for increasingly higher-risk recipients may further increase these complication rates. While treatments exist for DGF and acute rejection, the current diagnostic paradigm is to obtain a duplex ultrasound (DUS) of the allograft, based on serial changes in serum creatinine, and then proceed to biopsy if there is clinical concern for rejection. Biopsy is the gold standard to differentiate between causes of allograft dysfunction, but the procedure is invasive and typically takes 24 hours or longer for an interpretation. Thus, early detection of these complications using non-invasive diagnostic methods (a major transplant research goal) could reduce our reliance on biopsies and help improve long-term patient and allograft survival.
Researchers in the United States have safely performed contrast-enhanced ultrasounds of the kidney in healthy participants, and radiologists have used ultrasound contrast agents off-label to better visualize organs other than the heart when clinically indicated. In terms of kidney transplants, European data suggest CEUS of the allograft on post-operative day (POD) 7 is superior to DUS for predicting 12-month allograft function, but there are no published studies using CEUS on POD 1 to diagnose DGF or acute rejection.
The pathophysiology of both DGF and acute rejection involve interactions between the microvasculature, parenchymal cells and inflammatory cells, though with differences in timing and within different zones of the kidney itself. A very important feature of CEUS is its capacity to measure microvascular perfusion, whereas DUS can only estimate flow within larger vessels. This potential innovation for assessing the renal macro- and microvasculature may allow for earlier non-invasive detection of DGF and acute rejection. With additional research, it may ultimately be shown that non-invasive CEUS will revolutionize early DGF and acute rejection diagnosis to enable improvement in long-term patient and allograft survival.
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Benjamin Richeson
- Phone Number: 801-581-2982
- Email: ben.richeson@hsc.utah.edu
Study Locations
-
-
Utah
-
Salt Lake City, Utah, United States, 84132
- Recruiting
- University of Utah Hospital
-
Contact:
- Benjamin Richeson
- Phone Number: 801-581-2982
- Email: ben.richeson@hsc.utah.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adult living-donor or deceased-donor kidney transplant recipients
Exclusion Criteria:
- Subject is Pregnant
- History of non-renal transplant
- Uncontrolled diabetes or hypertension
- Symptomatic or significant pulmonary or cardiovascular disease
- Clinical decision by the treating team to forego the study procedure due to medical/surgical instability
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: CEUS and Delayed Graft Function
On the first post-operative day after kidney transplantation, recipients enrolled in the study will undergo CEUS using Lumason to quantify microvascular perfusion within the cortical and medullary zones of the kidney allograft for comparison to the concentration of neutrophil gelatinase-associated lipocalin (NGAL, an early biomarker of acute kidney injury) measured from recipient urine simultaneously collected on the first post-operative day.
|
In both arms, we will use Lumason to measure kidney allograft perfusion via contrast-enhanced ultrasound.
Other Names:
|
Experimental: CEUS and Biopsy-Proven Acute Rejection
We will identify and enroll kidney transplant recipients in need of clinically-indicated duplex ultrasounds and possible biopsy to evaluate allograft dysfunction during hospital admissions and outpatient follow-up.
Immediately after the duplex ultrasound, we will perform CEUS using Lumason for allograft perfusion measurements to determine its potential association with biopsy-proven acute rejection according to the most recent Banff criteria.
|
In both arms, we will use Lumason to measure kidney allograft perfusion via contrast-enhanced ultrasound.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Biomarker-Defined Delayed Graft Function
Time Frame: Post-Operative Day 1
|
A meta-analysis of 19 studies found urine neutrophil gelatinase-associated lipocalin (NGAL) >150 ng/mL (within hours of the inciting event) had an area under the receiver-operating characteristic curve (AUC) of 0.815 for identifying acute kidney injury (defined as an ensuing rise in serum creatinine by ≥50%).
We noted an AUC of 0.82 for predicting the need for dialysis in the first week (i.e., dialysis-defined delayed graft function) with an optimal urine NGAL cutoff of >350 ng/mL.
For this study outcome, we will determine the Spearman correlation between CEUS-assessed allograft perfusion and degree of allograft injury based on post-operative day 1 urine NGAL concentration.
|
Post-Operative Day 1
|
Biopsy-Proven Acute Rejection
Time Frame: Any Time After Kidney Transplantation
|
The Banff (2013) classification of acute kidney allograft rejection requires histologic evidence of acute tissue injury, evidence of recent antibody interaction with renal vascular endothelium, and serologic evidence of donor-specific antibodies in order to diagnose acute antibody-mediate rejection.
Acute T-cell mediated rejection is histologically graded by the extent of interstitial inflammation and vascular involvement.
|
Any Time After Kidney Transplantation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Dialysis-Defined Delayed Graft Function
Time Frame: First Post-Operative Week
|
The need for any dialysis in the first week of transplant.
|
First Post-Operative Week
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Isaac E Hall, M.D., University of Utah
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- IRB_00092223
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.
Clinical Trials on Kidney Transplantation
-
Astellas Pharma IncAstellas Pharma Europe B.V.CompletedKidney Transplantation | Renal Transplantation | Transplantation, Kidney | Grafting, Kidney | Transplantation, RenalBelgium, Germany, Spain, Sweden, Italy, Switzerland, United Kingdom, Austria, France, Poland, Czech Republic, Netherlands
-
Bristol-Myers SquibbCompletedKidney Transplantation: Transplantation, Kidney
-
Nantes University HospitalTerminated
-
Hospices Civils de LyonCompletedKidney Transplantation | Pancreas-kidney TransplantationFrance
-
Astellas Pharma Europe Ltd.CompletedLiver Transplantation | Kidney Transplantation | Heart TransplantationCzechia, France, Italy, Poland, United Kingdom
-
The Hospital for Sick ChildrenCompletedLiver Transplantation | Kidney Transplantation | Heart TransplantationCanada
-
Astellas Pharma Europe Ltd.TerminatedLiver Transplantation | Kidney Transplantation | Heart TransplantationBelgium, France, Germany, Poland, Spain, United Kingdom
-
Astellas Pharma Europe Ltd.CompletedLiver Transplantation | Kidney Transplantation | Heart TransplantationSpain, Australia, France, Germany, Canada, Italy, United Kingdom, Belgium, South Africa, Switzerland, Sweden, United States, Austria, Brazil, Czechia, Denmark, Finland, Hungary, Ireland, Mexico, Netherlands, New Zealand, Poland
-
Astellas Pharma Europe Ltd.CompletedLiver Transplantation | Kidney Transplantation | Heart TransplantationBelgium, France, Germany, Poland, Spain, United Kingdom
-
Medical University of ViennaUnknownKidney Function After Transplantation | Outcome After Kidney Transplantation
Clinical Trials on Lumason Contrast-Enhanced Ultrasound
-
Indiana UniversityRecruitingRenal Malignant TumorUnited States
-
Children's Hospital of PhiladelphiaBracco Diagnostics, Inc; Pediatric Orthopaedic Society of North AmericaRecruitingDevelopmental Dysplasia of the HipUnited States
-
Mayo ClinicCompletedCarotid Artery PlaqueUnited States
-
Mayo ClinicCompleted
-
Children's Hospital of PhiladelphiaRecruiting
-
Children's Mercy Hospital Kansas CityChildren's Hospital Colorado; St. Jude Children's Research Hospital; Nationwide...WithdrawnStem Cell Transplant Complications | Bone Marrow Transplant Complications | Sinusoidal Obstruction Syndrome | Veno Occlusive Disease, HepaticUnited States
-
Mayo ClinicWithdrawnSpontaneous Coronary Artery Dissection | Fibromuscular Dysplasia of Arteries | Segmental Arterial Mediolysis | Atherosclerosis of ArteryUnited States
-
Children's Hospital Medical Center, CincinnatiRecruiting
-
Children's Hospital of PhiladelphiaThe Ray E. Helfer SocietyActive, not recruitingAbdominal Injuries | Accidental Fall | Physical Abuse | Motor Vehicle InjuryUnited States
-
Mayo ClinicCompletedProliferative Breast DiseaseUnited States