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Tidlige signaler på overgangen fra immun quiescens til aktivering i leverallograftmikromiljøet og i cirkulationen (iSYNAPSE)

Tidlige signaler på overgangen fra immunstillstand til aktivering i levertransplantatets mikromiljø og i cirkulationen (RTB-018)

This is a prospective multi-center, longitudinal study to determine efficacy of 50 percent Immunosuppression (IS) reduction. One hundred fully eligible participants will reduce IS by 50 percent in two steps. Liver tests will be checked every 0.5 months through month 4, once a month through month 12, and every other month through month 18. Liver transplant (LTx) center visits will take place at screening, months 6, 12 and 18 after initiating IS dose reduction. A protocol driven liver biopsy to adjudicate the endpoint will be performed at 18 months. The duration of the study from time of starting IS dose reduction to the primary endpoint assessment is 18 months.

The primary objective is to assess the efficacy of 50 percent IS dose reduction in children with Liver transplants (LTxs)

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

100

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • California
      • San Francisco, California, Forenede Stater, 94143
        • Rekruttering
        • UCSF Benioff Children's Hospital
        • Kontakt:
    • Colorado
    • District of Columbia
      • Washington D.C., District of Columbia, Forenede Stater, 20007
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30307
        • Ikke rekrutterer endnu
        • Emory University School of Medicine/Children's Healthcare of Atlanta
        • Kontakt:
    • Illinois
      • Chicago, Illinois, Forenede Stater, 60611
        • Rekruttering
        • Ann and Robert H. Lurie Children's Hospital of Chicago
        • Kontakt:
    • New York
      • New York, New York, Forenede Stater, 10029
        • Rekruttering
        • Icahn School of Medicine at Mount Sinai
        • Kontakt:
      • New York, New York, Forenede Stater, 10032
    • Ohio
      • Cincinnati, Ohio, Forenede Stater, 45229
        • Rekruttering
        • Cincinnati Children's Hospital Medical Center
        • Kontakt:
    • Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 15224
        • Ikke rekrutterer endnu
        • Children's Hospital of Philadelphia
        • Kontakt:
      • Pittsburgh, Pennsylvania, Forenede Stater, 15213
        • Rekruttering
        • University of Pittsburgh Medical Center
        • Kontakt:
    • Tennessee
      • Nashville, Tennessee, Forenede Stater, 37232
        • Ikke rekrutterer endnu
        • Monroe Carell Jr. Children's Hospital at Vanderbilt
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

3 år til 13 år (Barn)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Participant and parent or guardian must be able to understand and provide informed assent and consent, respectively
  2. Recipient of a living or deceased donor Liver transplant (LTx) at <7 years of age
  3. > 3 years but <7 years after LTx at the time of study enrollment
  4. Stable liver tests defined as baseline serum alanine aminotransferase (ALT) level < 30 IU/l and gamma-glutamyl transferase (GGT) level < 50 IU/l (based on the average of the 3 most recent values prior to screening; all must be within 1 year of screening; 2 must be within 6 months of screening)
  5. No Acute rejection (AR) or chronic rejection within 12 months of enrollment
  6. Tacrolimus monotherapy for > 6 months with baseline 12-hour trough levels <8 ng/mL (based on the average of 3 values prior to screening; all must be within 1 year of screening; 2 must be within 6 months of screening)
  7. Participants of childbearing potential must have a negative pregnancy test upon study entry

Exclusion Criteria:

  1. Liver transplant (LTx) for autoimmune disease, including autoimmune hepatitis or primary sclerosing cholangitis
  2. LTx for hepatitis B or hepatitis C
  3. Recipient of any other organ transplant or liver re-transplant, except for patients who have a repeat LTx within 30 days of first LTx who are eligible for enrollment
  4. >=50 percent dose increase in tacrolimus within 12 months of enrollment
  5. Discontinued a second Immunosuppression (IS) agent within 12 months of enrollment
  6. Systemic illness requiring chronic or recurrent use of IS for which there is a risk of reactivation if tacrolimus is reduced
  7. Use of medication to treat systemic conditions which in the judgement of the investigator could influence results of the study
  8. Active or chronic infection requiring treatment
  9. Inability or unwillingness to comply with the study protocol
  10. Use of investigational drug within 4 weeks (or 5 half-lives of investigational drug, whichever is longer) of enrollment
  11. Has any condition that, in the opinion of the investigator, will interfere with safe participation in the trial

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: N/A
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: IS dose reduction

Eligible participants will reduce immunosuppression (IS) by 50 percent in two steps. For subjects taking tacrolimus once daily:

  1. reduce dose to 75 percent of initial dose for 6 weeks
  2. reduce dose to 50 percent of initial dose

For subjects taking tacrolimus twice daily:

  1. reduce evening such that the total daily dose is 75 percent of the initial dose for 6 weeks
  2. stop evening dose

For participants taking different doses of tacrolimus in the morning and evening, the clinical site will confer will the protocol chair and PI to determine the schedule for IS reduction

Prospective multi-center, longitudinal study to determine the success rate of 50% immunosuppression (IS) dose reduction. One hundred fully eligible participants will reduce IS by 50% in two steps

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Achieving successful 50 percent Immunosuppression (IS) reduction
Tidsramme: At 18 months

Defined as meeting both biochemical and histological criteria of stability

At 18 months

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Proportion of Acute Rejection (AR) Episodes Within Each Banff Severity Category
Tidsramme: At 18 months

The proportion of acute rejection (AR) episodes within each observed Banff severity category will be measured.

At 18 months
The proportion of participants who experience Acute rejection (AR)
Tidsramme: At 18 months

Defined as either biopsy-proven or clinical AR

At 18 months
Achieving clinically successful 50 percent Immunosuppression (IS) reduction
Tidsramme: At 18 months

Defined as meeting biochemical but not histological criteria of stability

At 18 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Studiestol: Sandy Feng, MD, Ph.D., University of California San Francisco School of Medicine: Transplantation
  • Studiestol: John Bucuvalas, M.D., Icahn School of Medicine at Mount Sinai: Transplantation

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

14. maj 2026

Primær færdiggørelse (Anslået)

1. april 2031

Studieafslutning (Anslået)

1. oktober 2031

Datoer for studieregistrering

Først indsendt

16. april 2026

Først indsendt, der opfyldte QC-kriterier

16. april 2026

Først opslået (Faktiske)

24. april 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

28. september 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

23. september 2026

Sidst verificeret

1. september 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • DAIT RTB-018

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .