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HOPE in Action Prospektivt multicenter, klinisk forsøg med afdøde HIVD+ nyretransplantationer til HIV+-modtagere

1. september 2026 opdateret af: Johns Hopkins University
Det primære formål med denne undersøgelse er at afgøre, om en HIV-inficeret afdød nyredonor (HIVD+) transplantation er sikker med hensyn til større transplantationsrelaterede og HIV-relaterede komplikationer.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Denne undersøgelse vil evaluere, om det er sikkert at modtage en nyretransplantation fra en HIV-inficeret afdød nyredonor med hensyn til overlevelse og større transplantationsrelaterede og HIV-relaterede komplikationer sammenlignet med at modtage en nyre fra en HIV-uinficeret afdød nyredonor (HIVD-) . De deltagere, der har accepteret et HIVD-organ, vil blive randomiseret til at blive fulgt i hele undersøgelsen eller fulgt i den indlejrede observationsgruppe.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

207

Fase

  • Ikke anvendelig

Kontakter og lokationer

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

Studiesteder

    • Alabama
      • Birmingham, Alabama, Forenede Stater, 35294
        • University of Alabama at Birmingham
    • Arkansas
      • Little Rock, Arkansas, Forenede Stater, 72205
        • University of Arkansas for Medical Sciences
    • California
      • Los Angeles, California, Forenede Stater, 90095
        • University of California, Los Angeles
      • San Diego, California, Forenede Stater, 92103
        • University of California, San Diego
      • San Francisco, California, Forenede Stater, 94193
        • University of California, San Francisco
    • Connecticut
      • New Haven, Connecticut, Forenede Stater, 06520-8022
        • Yale University School Of Medicine
    • District of Columbia
      • Washington D.C., District of Columbia, Forenede Stater, 20007
        • MedStar Georgetown Transplant Institute
    • Florida
      • Miami, Florida, Forenede Stater, 33136
        • Miami Transplant Institute
      • Weston, Florida, Forenede Stater, 33331
        • Cleveland Clinic Florida
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30322
        • Emory University
    • Illinois
      • Chicago, Illinois, Forenede Stater, 60612
        • University of Illinois at Chicago
      • Chicago, Illinois, Forenede Stater, 60611
        • Northwestern University
      • Chicago, Illinois, Forenede Stater, 60612
        • Rush University Medical Center
    • Indiana
      • Indianapolis, Indiana, Forenede Stater, 46202
        • Indiana University
    • Louisiana
      • New Orleans, Louisiana, Forenede Stater, 70121
        • Ochsner Medical Center
    • Maryland
      • Baltimore, Maryland, Forenede Stater, 21205
        • Johns Hopkins University
      • Baltimore, Maryland, Forenede Stater, 212101
        • University of Maryland, Institute of Human Virology
    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02114
        • Massachusetts General Hospital
    • New York
      • New York, New York, Forenede Stater, 10032
        • Columbia University Medical Center
      • New York, New York, Forenede Stater, 10065
        • Weill Cornell Medical College
      • New York, New York, Forenede Stater, 10016
        • New York University School of Medicine
      • New York, New York, Forenede Stater, 10029
        • Icahn School of Medicine at Mount Sinai
    • Ohio
      • Cincinnati, Ohio, Forenede Stater, 45267
        • University of Cincinnati
    • Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • University of Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 19102
        • Drexel University
      • Pittsburgh, Pennsylvania, Forenede Stater, 15213
        • UPMC-University of Pittsburgh Medical Center
    • Texas
      • Dallas, Texas, Forenede Stater, 75390
        • University of Texas Southwestern Medical Center
      • Dallas, Texas, Forenede Stater, 75203
        • Methodist Health System Clinical Research Institute
    • Virginia
      • Charlottesville, Virginia, Forenede Stater, 22908
        • University of Virginia

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

14 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

Inklusionskriterier:

  • Deltager opfylder standardkriterierne for nyretransplantation på lokalcentret.
  • Deltageren er i stand til at forstå og give informeret samtykke.
  • Deltageren mødes med en uafhængig fortaler i henhold til HIV Organ Policy Equity (HOPE) Act Safeguards.
  • Dokumenteret HIV-infektion (ved enhver licenseret analyse eller dokumenteret historie med påviselig HIV-1 RNA).
  • Ingen levende donor tilgængelig.
  • Deltageren er ≥18 år.
  • Opportunistiske komplikationer: hvis tidligere en opportunistisk infektion i anamnesen, har deltageren modtaget passende behandling og har ingen tegn på aktiv sygdom.
  • Cluster of Differentiation 4 (CD4)+ T-celle: ≥200/µL inden for 16 uger efter transplantation.
  • HIV-1 er under 50 kopier RNA/ml. Virale blips mellem 50-400 kopier tilladt, så længe der ikke er fortløbende mål >200 kopier/ml.
  • Deltageren er villig til at overholde al medicin relateret til deres transplantation og HIV-håndtering.
  • For deltagere med en historie med aspergillus kolonisering eller sygdom, ingen tegn på aktiv sygdom.
  • Deltageren skal have, eller være villig til at begynde at se, en primær læge med ekspertise i hiv-håndtering.
  • Alle deltagere, der deltager i seksuel aktivitet, der kan føre til graviditet, skal bruge en FDA-godkendt præventionsmetode.
  • Deltageren lider ikke af væsentligt spild (f.eks. BMI

Ekskluderingskriterier:

  • Deltageren har en historie med progressiv multifokal leukoencefalopati (PML) eller primært centralnervesystem (CNS) lymfom.
  • Deltageren er gravid eller ammer.
  • Tidligere eller nuværende medicinske problemer eller fund fra sygehistorie, fysisk undersøgelse eller laboratorieundersøgelser, som ikke er nævnt ovenfor, som efter investigatorens mening kan udgøre yderligere risici eller kan påvirke kvaliteten eller fortolkningen af ​​de data, der er opnået fra undersøgelsen.

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: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Ingen indgriben: HIV D-/R+ (observations)
HIV-inficerede individer, der accepterer et organ fra en HIV-ikke-inficeret afdød donor og randomiseret til observationsgruppe - tilmelding 200
Eksperimentel: HIV D+/R+
HIV-inficerede personer, der accepterer et organ fra en HIV-inficeret afdød donor - tilmelding 100
Nyre fra en HIV-smittet afdød donor
Ingen indgriben: HIV D-/R+
HIV-inficerede individer, der accepterer et organ fra en HIV-ikke-inficeret afdød donor - tilmelding 100

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Composite Event, Time to First Death or Graft Failure or Serious Adverse Event (SAE) or HIV Breakthrough or Opportunistic Infection
Tidsramme: From date of transplant through administrative censorship at study completion, up to 4 years
Time to first of any of the following events: death or graft failure or serious adverse event (SAE) or HIV breakthrough or HIV virologic failure or opportunistic infection
From date of transplant through administrative censorship at study completion, up to 4 years

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Pre-transplant Mortality
Tidsramme: At 1 and 2 years post-consent, prior to transplant
Cumulative incidence of mortality while enrolled before transplant
At 1 and 2 years post-consent, prior to transplant
Graft Failure
Tidsramme: At 1 and 3 years post transplant
Cumulative incidence of graft failure
At 1 and 3 years post transplant
Rate of Serious Adverse Events
Tidsramme: From date of transplant through graft failure or administrative censorship at study completion, up to year 4
Count of post-transplant serious adverse events per person-year as assessed by Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.0
From date of transplant through graft failure or administrative censorship at study completion, up to year 4
6-month Acute Rejection
Tidsramme: At 6 months post-transplant
Percentage of recipients who experience acute rejection as measured by biopsy using Banff 2015 criteria: Borderline changes: 'Suspicious' for acute T-cell mediated rejection.This category is used when no intimal arteritis is present, but there are foci of mild tubulitis (t1, t2, or t3) with minor interstitial infiltration (i0 or i1) or interstitial infiltration (i2, i3) with mild (t1) tubulitis. Acute T-cell mediated rejection:Grade from IA defined as cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) to III defined as cases with 'transmural' arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3). Outcome data of the observational group were obtained from the Scientific Registry of Transplant Recipients (September 2023 data export).
At 6 months post-transplant
1-year Acute Rejection
Tidsramme: From date of transplant to end of year 1
Percentage of recipients who experience acute rejection as measured by biopsy using Banff 2015 criteria: Borderline changes: 'Suspicious' for acute T-cell mediated rejection.This category is used when no intimal arteritis is present, but there are foci of mild tubulitis (t1, t2, or t3) with minor interstitial infiltration (i0 or i1) or interstitial infiltration (i2, i3) with mild (t1) tubulitis. Acute T-cell mediated rejection:Grade from IA defined as cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) to III defined as cases with 'transmural' arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3). Outcome data of the observational group were obtained from the Scientific Registry of Transplant Recipients (September 2023 data export).
From date of transplant to end of year 1
Incidence of Graft Rejection
Tidsramme: At 1 and 3 years post transplant
Cumulative incidence of acute rejection as measured by biopsy using Banff 2015 criteria: Borderline changes: 'Suspicious' for acute T-cell mediated rejection.This category is used when no intimal arteritis is present, but there are foci of mild tubulitis (t1, t2, or t3) with minor interstitial infiltration (i0 or i1) or interstitial infiltration (i2, i3) with mild (t1) tubulitis. Acute T-cell mediated rejection:Grade from IA defined as cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) to III defined as cases with 'transmural' arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3). Outcome data of the observational group were obtained from the Scientific Registry of Transplant Recipients (September 2023 data export).
At 1 and 3 years post transplant
Graft Function - Number of Participants With eGFR <60 mL/Min/1.73 m^2
Tidsramme: At 3 months post-transplant
Number of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2
At 3 months post-transplant
Graft Function - Number of Participants With eGFR <60 mL/Min/1.73 m^2
Tidsramme: At 6 months post-transplant
Number of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) <60 mL/min/1.73 m^2
At 6 months post-transplant
Graft Function - Number of Participants With eGFR <60 mL/Min/1.73 m^2
Tidsramme: 9 months post-transplant
Number of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) <60 mL/min/1.73 m^2
9 months post-transplant
Graft Function - Number of Participants With eGFR <60 mL/Min/1.73 m^2
Tidsramme: At year 1 post-transplant
Number of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) <60 mL/min/1.73 m^2
At year 1 post-transplant
Graft Function Number of Participants With eGRF<60 mL/Min/1.73 m^2
Tidsramme: At year 2 post-transplant
Percentage of participants with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) <60 mL/min/1.73 m^2
At year 2 post-transplant
Graft Function - Number of Participants With eGFR <60 mL/Min/1.73 m^2
Tidsramme: At year 3 post-transplant
Percentage of participants with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) <60 mL/min/1.73 m^2
At year 3 post-transplant
Graft Function -Mean eGFR
Tidsramme: 3 months post-transplant
Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
3 months post-transplant
Graft Function-mean eGFR
Tidsramme: 6 months post-transplant
Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
6 months post-transplant
Graft Function-mean eGFR
Tidsramme: 9 months post-transplant
Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
9 months post-transplant
Graft Function-mean eGFR
Tidsramme: 1 year post-transplant
Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
1 year post-transplant
Graft Function-mean eGFR
Tidsramme: 2 years post-transplant
Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
2 years post-transplant
Graft Function-mean eGFR
Tidsramme: 3 years post-transplant
Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
3 years post-transplant
Graft Function - Slope eGFR
Tidsramme: From date of transplant to end of follow-up, up to 4 years
The slope of glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) over time (longitudinal analysis)
From date of transplant to end of follow-up, up to 4 years
Donor and Recipient Apolipoprotein L1 (APOL1)
Tidsramme: Baseline
Percentage of transplant recipients with at least 1 apolipoprotein L1 (APOL1) risk variant in donor and recipient
Baseline
Participants With Undetectable HIV RNA
Tidsramme: From date of transplant through end of follow-up, up to 4 years
Trajectory of recipient plasma HIV RNA over time. Analysis of repeated measures of plasma HIV RNA (longitudinal model). Below 50 copies/mL was used as the threshold of undetectable HIV RNA.
From date of transplant through end of follow-up, up to 4 years
Trajectory of Recipient Cluster of Differentiation (CD4) Count Over Time
Tidsramme: From date of transplant through end of follow up, up to 4 years
Analysis of repeated measures of Cluster of Differentiation 4 (CD4) count (longitudinal model)
From date of transplant through end of follow up, up to 4 years
Incidence of Antiretroviral Resistance
Tidsramme: From date of transplant through end of follow-up, up to 4 years
Measured by local sites' Clinical Laboratory Improvement Amendments (CLIA) certified lab with episode of HIV breakthrough defined as 2 consecutive plasma HIV viral loads >200 copies/mL or one HIV viral load >1000 copies/mL after a period of virologic control post-transplant
From date of transplant through end of follow-up, up to 4 years
Incidence of X4 Tropic Virus
Tidsramme: From date of transplant through end of follow-up, up to 4 years
Measured by local sites' Clinical Laboratory Improvement Amendments (CLIA) certified lab with episode of HIV breakthrough defined as 2 consecutive plasma HIV viral loads >200 copies/mL or one HIV viral load >1000 copies/mL after a period of virologic control post-transplant
From date of transplant through end of follow-up, up to 4 years
Incidence of Opportunistic Infection
Tidsramme: From date of transplant through end of follow-up, up to 4 years
Cumulative incidence of opportunistic infections
From date of transplant through end of follow-up, up to 4 years
Incidence of Surgical Complications
Tidsramme: From date of transplant through year 1
Number of surgical complications within 1 year of transplant, e.g. delayed closure, wound dehiscence
From date of transplant through year 1
Incidence of Vascular Complications
Tidsramme: From date of transplant through year 1
Number of vascular complications within 1 year of transplant
From date of transplant through year 1
Incidence of Viral-related Malignancies
Tidsramme: From date of transplant through end of follow-up, up to 4 years
Number of malignancies as determined by local pathology
From date of transplant through end of follow-up, up to 4 years
Participants With Formation of de Novo Donor-specific Human Leukocyte Antigen(HLA) Antibodies
Tidsramme: From date of transplant through end of year 1
Participants must have donor-specific HLA data at both day 0 and at 1 year to be included in the analysis. A total of 32 HIV D+/R+ and 40 HIV D-/R+ participants were excluded due to missing donor-specific data at either day 0 or 1 year.
From date of transplant through end of year 1
Composite Event, Cumulative Incidence
Tidsramme: At 6 months, 1 and 3 years post-transplant
Cumulative incidence of the composite event, which is defined as the occurrence of first event of any of all-cause-mortality or graft failure or renal allograft rejection or HIV breakthrough or HIV virologic failure or AIDS defining illness
At 6 months, 1 and 3 years post-transplant

Samarbejdspartnere og efterforskere

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

Efterforskere

  • Ledende efterforsker: Christine Durand, MD, Johns Hopkins University

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.

Generelle publikationer

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)

19. april 2018

Primær færdiggørelse (Faktiske)

30. september 2022

Studieafslutning (Faktiske)

1. maj 2024

Datoer for studieregistrering

Først indsendt

2. april 2018

Først indsendt, der opfyldte QC-kriterier

12. april 2018

Først opslået (Faktiske)

18. april 2018

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

3. september 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

1. september 2026

Sidst verificeret

1. september 2026

Mere information

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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 .

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