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Nyretransplantationsforebyggende terapi eller profylakse til CMV -forebyggelse hos D+R -modtagere (KPoP)

29. oktober 2026 opdateret af: University of California, San Francisco

Nyretransplantationsforebyggende terapi eller profylakse (KPOP) til CMV-forebyggelse hos D+R-modtagere

This is a prospective, randomized multicenter trial of preemptive therapy (PET) vs. antiviral prophylaxis (AP) for prevention of cytomegalovirus (CMV) disease in adult D+R- kidney transplant recipients (KTR). Patients meeting study eligibility criteria and who have provided informed consent will be randomized (1:1) within 7 days of transplant to receive, in an open label design, either AP with valganciclovir 900 mg orally once daily or letermovir 480 mg orally once daily [both dose adjusted per Food and Drug Administration (FDA) label] for 200 days post-transplant), or PET (central lab weekly plasma polymerase chain reaction (PCR) monitoring for CMV deoxyribonucleic acidemia (DNAemia)) for 100 days post-transplant, with oral valganciclovir 900mg orally twice daily (or renally dosed per FDA label) at onset of CMV DNAemia at any level and continued until plasma CMV DNAemia is negative or below the level of quantitation in two consecutive weekly plasma samples. Study participants will be followed for pre-specified outcomes (clinical, laboratory, immunologic, safety) until withdrawal, death, or study closure, up to a maximum of 5.5 years post-transplant. Approximately 360 participants (180 participants in each group) will be randomized into the study.

Estimated Time to Complete Enrollment: 4 years

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

360

Fase

  • Fase 3

Kontakter og lokationer

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

Studiekontakt

Studiesteder

  • Forenede Stater
    • California
      • San Francisco, California, Forenede Stater, 94117
        • Rekruttering
        • University of California, San Francisco School of Medicine
        • Kontakt:
    • Florida
      • Miami, Florida, Forenede Stater, 33136
        • Rekruttering
        • University of Miami Miller School of Medicine
        • Kontakt:
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30322
        • Rekruttering
        • Emory University School of Medicine
        • Kontakt:
    • Nebraska
      • Omaha, Nebraska, Forenede Stater, 68198
        • Ikke rekrutterer endnu
        • University of Nebraska Medical Center
        • Kontakt:
        • Ledende efterforsker:
          • Sias Scherger, MD
    • New Jersey
      • Livingston, New Jersey, Forenede Stater, 07039
        • Rekruttering
        • Robert Wood Johnson Health Network Barnabas Health
        • Kontakt:
    • North Carolina
      • Durham, North Carolina, Forenede Stater, 27708
        • Rekruttering
        • Duke University
        • Kontakt:
        • Ledende efterforsker:
          • Scott Sanoff, MD
    • Texas
      • Dallas, Texas, Forenede Stater, 75390
        • Ikke rekrutterer endnu
        • University of Texas Southwestern
        • Kontakt:
        • Ledende efterforsker:
          • Ricardo La Hoz, MD
    • Virginia
      • Richmond, Virginia, Forenede Stater, 23219
        • Rekruttering
        • Medical College of Virginia Commonwealth
        • 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

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Subject has provided written informed consent.

  2. Age ≥ 18 years of age at the time of informed consent.

  3. Negative for IgG antibody to CMV as assessed in a CLIA-certified laboratory between 28 days prior to transplant and up to 10 days post-transplant but prior to randomization.

  4. Received a kidney transplant from a CMV seropositive (IgG positive) donor in the past 10 days prior to enrollment

  5. Individuals of reproductive (childbearing) potential must have a negative pregnancy test (serum or urine) collected prior to randomization (SOC results within 7 days prior to transplant may be used), and must also agree to use a medically approved method of contraception. Acceptable methods include: barrier method, intrauterine device (hormonal or non-hormonal), oral hormonal contraceptives, abstinence from the time of enrollment through until discontinuation of ganciclovir or valganciclovir in either arm during the intervention period.

    NOTE: Individuals of reproductive potential are defined as individuals who have reached menarche and who have not been post-menopausal for at least 12 consecutive months with follicle stimulating hormone (FSH) ≥40 IU/mL or 24 consecutive months if an FSH is not available, i.e., who have had menses within the preceding 24 months, and have not undergone a sterilization procedure (e.g., hysterectomy, bilateral oophorectomy, or salpingectomy).

  6. If male, must agree to practice a barrier method of contraception or abstinence from the time of enrollment through 3 months after discontinuation of ganciclovir or valganciclovir in either arm during the intervention period.

Exclusion Criteria:

  1. In the opinion of the investigator, participants who are unable or unwilling to undergo preemptive therapy protocol (weekly CMV PCR, etc.)

  2. Patients who are breastfeeding or planning to breastfeed within 6 months post-transplant

  3. Allergy to valganciclovir/ganciclovir or Letermovir

  4. Receipt of immunoglobulin or CMV-specific immunoglobulin within the last 3 months prior to the qualifying CMV IgG serology as described in inclusion criteria #3 (this includes COVID convalescent plasma)

  5. Currently enrolled or anticipated enrollment in another interventional study that, in the opinion of scientific leadership team, could affect evaluation of the primary safety and/or efficacy outcomes.

  6. Most recent platelet count post-transplant <25,000/uL

  7. Most recent ANC performed post-transplant <1000/uL

  8. Multi-organ transplant (except simultaneous kidney-pancreas) within the past 7 days

  9. Prior or planned receipt of a hematopoietic cell transplant

  10. Baseline immunodeficiency prior to transplant, including but not limited to:

    1. Known or suspected HIV infection
    2. Congenital or acquired immunodeficiency

  11. Unacceptable immunosuppression

    1. Receipt of desensitization therapy prior to kidney transplant, or
    2. Receipt of an ABO-incompatible kidney transplant except A2 to blood type B

Studieplan

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

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Forebyggelse
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Pre-emptive Therapy

900 mg of Valganciclovir given orally twice daily to Preemptive Therapy subjects upon detection of CMV viremia until plasma PCR is negative on two consecutive weekly PCR test. All dosages adjusted for renal dysfunction.
Medicin: Valganciclovir (Pre-emptive CMV Therapy)

Valganciclovir, 900 mg given orally twice daily to Preemptive Therapy group subjects as a PET only after a positive CMV PCR test and stopped after PCR is negative for 2 consecutive weeks.
Aktiv komparator: Prophylaxis

900 mg of Valganciclovir given orally once daily to subjects for 200 days post transplantation. All dosages adjusted for renal dysfunction.
Medicin: Valganciclovir CMV Prophylaxis

Valganciclovir, 900 mg given orally once daily to all Prophylaxis group subjects for 200 days post transplantation as prophylaxis.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
Forekomst af Endpoint Committee (EC) -bekræftet CMV-sygdom (enten syndrom eller slutorgan) med 1-årig post-transplantation.
Tidsramme: Inden for 1-årig post-transplantation
Inden for 1-årig post-transplantation

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Andel af deltagere med efterforskerbestemt CMV-sygdom
Tidsramme: af 1-årig posttransplantation
af 1-årig posttransplantation
Tid i dage til biopsi-beviset akut afvisning (BIPAR)
Tidsramme: Fra datoen for randomisering til datoen for BIPAR fra enhver årsag, vurderet op til 5,5 år
Fra datoen for randomisering til datoen for BIPAR fra enhver årsag, vurderet op til 5,5 år
Tid i dage til transplantattab
Tidsramme: Fra datoen for randomisering til datoen for transplantattab fra enhver årsag, vurderet op til 5,5 år
Fra datoen for randomisering til datoen for transplantattab fra enhver årsag, vurderet op til 5,5 år
Tid i dage til døden
Tidsramme: Fra datoen for randomisering til dødsdatoen fra enhver årsag, vurderet op til 5,5 år
Fra datoen for randomisering til dødsdatoen fra enhver årsag, vurderet op til 5,5 år
Gennemsnitlig estimeret glomerulær filtreringshastighed (EGFR) i ml/min/1,73m2 ved 1, 2, 3 og 4-år efter transplantation
Tidsramme: 1, 2, 3 og 4-år efter transplantation
1, 2, 3 og 4-år efter transplantation
Non-inferiority of PET (within a 10% margin) vs AP for EC-confirmed CMV disease by 1-year post-transplant, contingent on failure to meet the primary superiority endpoint.
Tidsramme: by 1-year post-transplant

Although the study sample size is powered to detect the superiority of one preventive strategy compared to the other, it is possible that the two approaches may have similar efficacy with respect to prevention of CMV disease. Therefore, should there be insufficient evidence to conclude superiority of one of the approaches, a key Secondary Outcome is a non-inferiority assessment of preemptive therapy to prophylaxis, assuming a non-inferiority margin of 10%. This margin is based on what is known about the effectiveness of the two approaches as published in literature and the potential that the two strategies could be similarly efficacious in preventing CMV disease. The success rate for the prophylaxis group is estimated to be ~80% based on a systematic review and meta-analysis with hypothesized success rates for the preemptive group expected to be higher.
by 1-year post-transplant

Samarbejdspartnere og efterforskere

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

Sponsor

University of California, San Francisco

Samarbejdspartnere

National Institute of Allergy and Infectious Diseases (NIAID)

Efterforskere

  • Ledende efterforsker: Abhijit P. Limaye, MD, University of California, San Francisco

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)

22. juli 2025

Primær færdiggørelse (Anslået)

30. november 2030

Studieafslutning (Anslået)

31. maj 2031

Datoer for studieregistrering

Først indsendt

17. januar 2025

Først indsendt, der opfyldte QC-kriterier

27. januar 2025

Først opslået (Faktiske)

29. januar 2025

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

2. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

29. oktober 2026

Sidst verificeret

1. oktober 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • STUDY00020695
  • 1R01AI184205-01 (U.S. NIH-bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

produkt fremstillet i og eksporteret fra U.S.A.

Ingen

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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