Study to Evaluate the Safety and Efficacy of the 10 GE Xenokidney in Patients With ESRD (EXPAND)

EXPAND: A Prospective Study to Evaluate the Safety and Efficacy of the 10 GE Xenokidney in Patients With End-stage Renal Disease (ESRD)

The purpose of this study is to evaluate the safety and efficacy of the 10 GE Xenokidney in patients with ESRD who are either not eligible for conventional allogeneic kidney transplantation (Group 1) or are on an Organ Procurement and Transplantation Network (OPTN) kidney transplant waitlist, but are more likely to die or go untransplanted within 5 years than receive a kidney transplant (Group 2).

The study consists of xenotransplantation followed by a 24-week Post-transplant Follow up Period (Part A) to evaluate the efficacy and safety objectives followed by a Long-term Follow-up Period (Part B) to evaluate participant survival, 10 GE Xenokidney survival, and screening for zoonotic infections. Part B will continue for the lifetime of the participant.

Study Overview

• Status: Recruiting
• Conditions: Kidney Transplantation; ESRD (End-Stage Renal Disease); Xenotransplantation
• Intervention / Treatment: Biological: 10 GE Xenokidney

Detailed Description

This is a Phase 1/2/3, multicenter, open-label, safety and efficacy study of the 10 GE Xenokidney in patients with ESRD. The study will be comprised of the following:

• A Screening Period up to 52 weeks.
• Part A consists of the 10 GE Xenokidney transplantation followed by a 24-week Post-transplant Follow-up Period, including the evaluation of all study endpoints and safety assessments.
• Part B is a Long-term Follow-up Period that extends for the lifetime of participants who received the 10 GE Xenokidney, including but not limited to documentation of participant survival, 10 GE Xenokidney survival, and screening for zoonotic infections.

There will be 2 groups of participants enrolled in the study. Group 1 will be participants deemed ineligible for conventional allogeneic kidney transplantation due to medical reason(s). Group 2 will be participants on an OPTN kidney transplant waitlist but are more likely to die or go untransplanted within 5 years than receive a kidney transplant.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: United Therapeutics Global Medical Information; Phone Number: 919-485-8350; Email: clinicaltrials@unither.com

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Recruiting
      • Northwestern Memorial Hospital
      • Contact: Michelle Callegari; Email: michelle.callegari@northwestern.edu
      • Principal Investigator: Satish N Nadig, MD, PhD, FACS
  • New York
    • New York, New York, United States, 10016
      • Recruiting
      • New York University Langone Health
      • Contact: Karen Khalil; Phone Number: 347-514-2758; Email: karen.khalil@nyulangone.org
      • Principal Investigator: Robert A Montgomery, MD, DPhil

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria for all Participants (Groups 1 and 2):

1. Provide voluntarily informed consent to participate in the study and for lifetime follow up.
2. Have a diagnosis of ESRD at the time of informed consent.
3. Hemodialysis dependent for a minimum of 6 months and has a functioning arterial venous fistula/graft or permanent catheter at the time of informed consent.
4. 50 to 70 years of age at the time of informed consent, or 40 to <50 years of a age with a calculated panel reactive antibody (cPRA) of ≥99.9%.
5. Live withing 3 hours travel time of the xenotransplant center.
6. Female participants must be postmenopausal or permanently sterilized (eg, hysterectomy, bilateral oophorectomy, or bilateral salpingectomy). Male participants must agree to the use of a highly effective method of birth control, if the possibility of conception exists.
7. Negative xeno-crossmatch at Screening and pre-transplant.
8. Estimated Post Transplant Survival Calculator score >20% (https://optn.transplant.hrsa.gov/data/allocation-calculators/epts-calculator/).
9. Body mass index ≤35 kg/m2.
10. Have completed or have initiated and plan to complete (meningococcal A, C, W, Y and meningococcal B vaccine series only) Centers for Disease Control and Prevention recommended courses of age and risk factor appropriate vaccinations.
11. Seropositive (immunoglobulin G) for cytomegalovirus and Epstein-Barr virus.

Additional Inclusion Criteria for Group 1:

1. Ineligible for conventional allogeneic kidney transplantation due to medical reason(s) for any of the following:

1. Ineligible for a living donor transplant.
2. Ineligible for an OPTN kidney transplant waitlist (reason for ineligibility will be collected).
3. Delisted from OPTN kidney transplant waitlist (reason for delisting will be collected).

Additional Inclusion Criteria for Group 2:

1. On an OPTN kidney transplant waitlist (active or inactive status).
2. No approved living kidney donors.
3. More likely to die or go untransplanted within 5 years than receive a kidney transplant as measured by the Kidney Transplant Decision Aid at the time of informed consent (select United States for "Choose your state" field and National average for "Choose your transplant program" field; https://www.srtr.org/tools/kidney-transplant-decision-aid/).

Exclusion Criteria (pertain to all participants in Groups 1 and 2):

1. Need for multiple organ transplants.

2. Severe medical co-morbidities including, but not limited to:

   1. Chronic liver disease.
   2. Advanced cardiovascular disease.
   3. Severe peripheral vascular disease that limits technical ability to transplant the 10 GE Xenokidney.
   4. Severe neurologic diseases or conditions that would preclude meaningful recovery or informed consent.
   5. Oral steroid-dependent airway disorder or chronic pulmonary disease or requires chronic, intermittent or continuous supplemental oxygen.
   6. Pulmonary hypertension.
   7. Uncontrolled diabetes or sequelae of diabetes mellitus including severe non-proliferative diabetic retinopathy.
   8. Severe neurogenic bladder that requires intermittent catheterization.
3. ESRD due to hereditary or structural kidney disease.
4. Active or recently treated malignancy at the time of informed consent.
5. Non-renal cause of hematological disorders associated with anemia (eg, thalassemia and sickle disease).
6. Cannot discontinue chronic anticoagulation therapy (low-dose daily aspirin is permissible).
7. History of major psychiatric disorders with a psychiatric hospitalization and/or suicidal ideation within 5 years of informed consent.
8. Being treated for active tuberculosis (TB), have received prophylaxis for positive FDA-approved interferon-gamma release assay, or test positive for TB by FDA-approved interferon-gamma release assay test during Screening.
9. Nucleic acid test (NAT) positive for hepatitis B virus and/or hepatitis C virus, hepatitis B surface antibody (anti HBs) titer <10 mIU/mL unless the participant is determined to be a nonresponder to hepatitis B vaccination (a nonresponder is defined as having an anti-HBs titer <10 mIU/mL after having completed both the standard vaccine series and a fourth booster dose and/or second standard vaccine series), and/or positive for human immunodeficiency virus (HIV; HIV-1 and HIV-2 antibody and/or NAT).
10. Not able to independently perform activities of daily life.
11. Have a history of medical noncompliance that may preclude adherence to the demands and requirements of xenotransplantation (eg, history of substance use disorder (SUD) within 1 year of informed consent, lack of social support, untreated psychological conditions).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 10 GE Xenokidney; Participants will receive 10 GE Xenokidney	Biological: 10 GE Xenokidney; Porcine-derived kidney containing intentional genomic alterations for xenotransplantation; Other Names: Xenokidney; UKidney

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival Rate of Patients with ESRD Receiving the 10 GE Xenokidney at 24 Weeks Post Transplant	Participant survival rate at 24 weeks post transplant.	Day 0 (day of xenotransplantation) to 24 weeks post transplant
Survival Time of Participants Receiving the 10 GE Xenokidney	Participant survival post transplant. Participant survival is defined as time from xenotransplantation to death for any cause	Day 0 (day of xenotransplantation) until death for any cause, assessed at least every 24 weeks after transplantation while the participant is alive, up to 50 years
Quality of Life in Participants Receiving the 10 GE Xenokidney by EuroQol 5-Dimension 5-Level (EQ-5D-5L)	Change in the EQ-5D-5L from baseline to 24 weeks post transplant. The EQ-5D-5L questionnaire assesses health-related quality of life across 5 categories (Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression). Each category has 5 levels, ranging from 1 (no problems) to 5 (extreme problems or inability to perform the activity). Higher scores indicate a worse health outcome (more mobility issues, greater pain, more anxiety, etc).	Baseline to 24 weeks post transplant
Quality of Life in Participants Receiving the 10 GE Xenokidney by Standardized Outcomes in Nephrology Life Participant (SONG-LP)	Change in SONG-LP from baseline to 24 weeks post transplant. The SONG-LP assesses participation in different life activities over the past month. The minimum score (worst outcome) is 4 (if all responses are "1" - Never) and the maximum score (best outcome) is 20 (if all responses are "5" - Always). Higher scores indicate a better health outcome (greater ability to participate in activities).	Baseline to 24 weeks post transplant
Quality of Life in Participants Receiving the 10 GE Xenokidney by Kidney Transplant Questionnaire (KTQ)	Change in KTQ from baseline to 24 weeks post transplant. Each question in the KTQ is scored on a 1 to 7 scale with: 1 = worst outcome (eg, "A very great deal of trouble or distress" / "All of the time") and 7 = best outcome (eg, "No trouble or distress" / "None of the time"). Higher scores indicate a better outcome, meaning less distress, fewer symptoms, and better well-being.	Baseline to 24 weeks post transplant
Quality of Life in Participants Receiving the 10 GE Xenokidney by Patient Global Impression of Change (PGI-C)	PGI-C at 24 weeks post transplant. The PGI-C assesses a patient's perception of improvement or worsening over time. The minimum score (best outcome) is 1 ("Very Much Improved") and the maximum score (worst outcome) is 7 ("Very Much Worse"). Higher scores indicate a worse health outcome (greater worsening).	At 24 weeks post transplant
Incidence of Treatment-Emergent Adverse Events (Safety of the 10 GE Xenokidney)	Incidence of adverse events and serious adverse events; all-cause mortality.	Baseline until last visit, assessed at least every 24 weeks after transplantation while the participant is alive and the xenokidney is functional, up to 50 years, or for 1 year after nephrectomy if required
Incidence of Proteinuria	Incidence of proteinuria from Day 0.	Day 0 (day of xenotransplantation) until last visit, assessed at least every 24 weeks after transplantation while the participant is alive and the xenokidney is functional, up to 50 years, or for 1 year after nephrectomy if required
Incidence of Zoonotic Infection	Incidence of zoonotic infection from Day 0.	Day 0 (day of xenotransplantation) until last visit, assessed at least every 24 weeks after transplantation while the participant is alive and the xenokidney is functional, up to 50 years, or for 1 year after nephrectomy if required
Incidence of Opportunistic Infection	Incidence of opportunistic infection from Day 0.	Day 0 (day of xenotransplantation) until last visit, assessed at least every 24 weeks after transplantation while the participant is alive and the xenokidney is functional, up to 50 years, or for 1 year after nephrectomy if required
10 GE Xenokidney Function Post Transplant (Endogenous GFR)	Endogenous measured GFR (24-hour urine creatinine clearance) at 24 weeks post transplant.	At 24 weeks post transplant
10 GE Xenokidney Function Post Transplant (Exogenous GFR)	Exogenous measured GFR (nuclear medicine GFR) at 24 weeks post transplant.	At 24 weeks post transplant
Survival Rate of the 10 GE Xenokidney at 24 Weeks Post Transplant	10 GE Xenokidney survival rate at 24 weeks post transplant. 10 GE Xenokidney failure is defined as 10 GE Xenokidney nephrectomy.	Day 0 (day of xenotransplantation) to 24 weeks post transplant
Survival Time of the 10 GE Xenokidney (Overall Survival)	Overall survival of the 10 GE Xenokidney post transplant. Overall survival time of the 10 GE Xenokidney is defined as time from xenotransplantation to 10 GE Xenokidney nephrectomy or death, whichever occurs first.	Day 0 (day of xenotransplantation) until start of chronic dialysis, nephrectomy, or death, whichever occurs first, assessed at least every 24 weeks after transplantation while the participant is alive and the xenokidney is functional, up to 50 years
Survival Time of the 10 GE Xenokidney (Death-censored Survival)	Death-censored survival 10 GE Xenokidney. Death-censored survival time of the 10 GE Xenokidney is defined as time from xenotransplantation to 10 GE Xenokidney nephrectomy censored for death.	Day 0 (day of xenotransplantation) until start of chronic dialysis, nephrectomy, or death, whichever occurs first, assessed at least every 24 weeks after transplantation while the participant is alive and the xenokidney is functional, up to 50 years

Collaborators and Investigators

• Sponsor: United Therapeutics

Study record dates

Study Major Dates

• Study Start (Actual): October 29, 2025
• Primary Completion (Estimated): October 1, 2028
• Study Completion (Estimated): October 1, 2075

Study Registration Dates

• First Submitted: March 3, 2025
• First Submitted That Met QC Criteria: March 12, 2025
• First Posted (Actual): March 17, 2025

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: ESRD; End-stage renal disease; Xenotransplantation; 10 GE Xenokidney
• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Chronic Disease; Disease Attributes; Renal Insufficiency; Pathological Conditions, Signs and Symptoms; Kidney Failure, Chronic; Renal Insufficiency, Chronic
• Other Study ID Numbers: GPK-KF-101

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