- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03240822
Human Penile Tissue Allotransplantation for Devastating Penile and Concomitant Genital Trauma
April 9, 2021 updated by: Wake Forest University Health Sciences
Vascularized Composite Allotransplantation (VCA) for Devastating Penile and Concomitant Genital Trauma
This is a 4-year, non-randomized, single center, patient self-controlled, clinical trial (though enrolled subjects will be followed for life as are all transplant patients) for patients seeking allotransplantation of the male external genitalia (MEG), or penile tissue, as a feasible reconstructive strategy for the treatment of devastating and irreversible injuries to the genitalia.
In addition to receiving penile allotransplantation and post-operative monitoring and support, enrolled patients will receive an innovative and clinically proven immunomodulatory protocol that combines lymphocyte depletion of the recipient with donor bone marrow cell infusion.
Patients will be treated with lymphocyte depleting induction therapy, donor bone marrow cell infusion and tacrolimus.
After the first year, maintenance immunosuppression will be modified gradually and cautiously (tapered dose reduction or spaced frequency dosing of tacrolimus) in selected patients based on a critical evaluation of clinical and immunologic outcomes.
Outcomes will include but not be limited to functional metrics (sensation, erection, voiding), psychosocial (body integrity, adaptation to transplant) and health related quality of life (HRQOL) measures.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
Initial treatment with an antibody targeting recipient immune cells followed by triple-drug maintenance therapy represents the current standard in clinical VCA.
Our protocol is different from the existing conventional drug treatments used in MEG allotransplantation in that it combines donor bone marrow infusion with an immunosuppression sparing protocol.
The primary goal of this pilot clinical trial is to determine the feasibility of using allogeneic penile tissue to repair/replace irreversibly damaged external genitalia.
Enrolled and transplanted subjects will be followed for their lifetime as a transplant patient.
Study Type
Interventional
Phase
- Phase 1
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 35 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Male
Description
Inclusion Criteria: For Recipients
- Male
- 18-40 years
- Irreversible and devastating genitalia damage not amenable to conventional reconstruction.
- Patent main vessels leading into the remaining penile stump, as confirmed by angiography.
- Adequate penile stump (> 2.5cm) to facilitate placement of a tourniquet, debridement of the distal portion and sufficient distal mobilization of the structures requiring anastomosis
- Eligible for long term standard of care coverage
Exclusion Criteria: For Recipients
Documented history of:
- cancer
- renal impairment
- hepatic disorders
- neurologic disorders (sensory or motor function deficits)
- severe scarring with poor host tissue bed
- penile resection or implant surgery
- diabetes
- hypertension
- hyperlipidemia
- coronary artery disease
- untreated genital cancer
- HIV, Hepatitis B or C, or any infectious disease
- erectile dysfunction
- Peyronie's disease
- urethral stricture disease
- balanitis
- xerotica obliterans
- pelvic embolization
- pelvic radiation
- untreated hypogonadism
- prior prostate surgery
- recurrent urinary tract infections (UTIs)
- nephrolithiasis
- connective tissue disease or collagen disease
- lipopolysaccharidosis or amyloidosis
- Use of 5-alpha-reductase inhibitors
- External signs, sequelae or positive serology of sexually transmitted disease (including HPV)
- Active UTI, stones, urethral edema and other pathology that prevents urethral anastomosis
- Current or past substance abuse
- Current or past smoker (within past 3 months)
- Use of any medications known to cause vasoconstriction
- Psychiatric illness or psychological problems, or deemed unsuitable on psychiatric evaluation
- Any condition that may prevent transplantation (positive cross match, high panel reactive antibody (PRA), etc.)
- Uncontrolled bleeding disorder, platelet count > 50,000, hemophilia or any other inherited coagulopathy or need to routinely receive blood products for bleeding disorders
- Concurrent participation in any other clinical investigation during the period of this investigation
- Inability to undergo leukapheresis
- Inability to participate in all necessary study activities due to physical or mental limitations
- Inability or unwillingness to return for all required follow-up visits.
- Inability or unwillingness to sign the patient informed consent document.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
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 |
---|---|
Experimental: Penile Allotransplant and Immunosuppression Treatment
Penile transplantation with monoclonal antibody induction therapy of humanized anti CD52 followed by donor bone marrow infusion and tacrolimus monotherapy.
|
Penile Allotransplantation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Need for Immunosuppressive drug therapy
Time Frame: 6 months
|
The amount of immunosuppressive drug therapy will be recorded.
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
erectile function
Time Frame: 6 months
|
This will be assessed following intracorporal injection of vaso-active agents, such as prostaglandin, phentolamine, papaverine, or some mixture of these drugs (i.e.
Trimix).
and through high-resolution duplex Doppler ultrasonography
|
6 months
|
Assessment of sensory return and sensory thresholds
Time Frame: 6 months
|
This will be accomplished by penile biothesiometry
|
6 months
|
Determination of hemodynamic status
Time Frame: 6 months
|
Dynamic infusion pharmaco-cavernosometry and cavernosography will be utilized to better understand these changes
|
6 months
|
The Reintegration to Normal Living (RNL) Index
Time Frame: 6 months
|
The RNL is an 11-item questionnaire that asks how a person manages activities, roles, and relationships on a day-to-day basis.
|
6 months
|
The Situational Inventory of Body-Image Dysphoria (SIBID)
Time Frame: 6 months
|
The SIBID is a multidimensional body-image survey assessment of people's negative body-image emotions in everyday situations and physical experiences.
|
6 months
|
The Function and Body Image Survey
Time Frame: 6 months
|
This survey consists of six open-ended questions regarding personal thoughts, opinions, and experiences about the transplant, and the individual's current functional abilities.
|
6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Anthony Atala, MD, Professor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 1, 2017
Primary Completion (Anticipated)
December 1, 2022
Study Completion (Anticipated)
December 1, 2025
Study Registration Dates
First Submitted
August 2, 2017
First Submitted That Met QC Criteria
August 4, 2017
First Posted (Actual)
August 7, 2017
Study Record Updates
Last Update Posted (Actual)
April 14, 2021
Last Update Submitted That Met QC Criteria
April 9, 2021
Last Verified
July 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00027539
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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