Diagnosis of Acute Rejection in Renal Transplant Patients by Urine Mass Spectrometry
Non-invasive Diagnosis of Acute Rejection in Renal Transplant Patients Using Mass Spectrometry of Urine Samples - a Multicentre Diagnostic Phase III Trial
Reliable and timely detection of acute rejections in renal transplant patients is important to preserve the graft function and to prevent premature graft failure. The current gold standard for the rejection diagnosis is a renal biopsy which is usually performed upon an unexplained decline in the graft function (determined by serum creatinine or clearance). Because of the insensitivity of creatinine determinations and the invasiveness of renal biopsies, non-invasive tests have been suggested to diagnose acute rejection including mass spectrometry (MS) analysis of urine samples.
The ability of MS analysis to detect acute rejection has been demonstrated in small studies on selected patients but evidence is lacking that this test is efficacious in the routine setting of the post-transplant patient care. Based on our previous work that established urine peptide sets for acute rejection by MS, a prospective, multicentre diagnostic phase III study will be executed.
The aim of the study is to prove that this test is as equally effective as the allograft biopsy to detect acute rejection in patients that undergo a biopsy for unexplained renal dysfunction. The perspective of this approach is that the test could be used either in place of the biopsy or as decision guidance whether a biopsy is necessary to confirm the presence of rejection. Another perspective is that the MS test (respectively, a simplified test system derived from this method) could be used in the regular post-transplant surveillance for acute rejection, in place of the relatively insensitive procedure with periodic monitoring of the graft function by creatinine determinations.
調査の概要
状態
条件
研究の種類
入学 (実際)
連絡先と場所
研究場所
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Aachen、ドイツ、52074
- RTW University of Aachen
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Berlin、ドイツ、10117
- Charité Universitätsmedizin Berlin
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Erlangen、ドイツ、90154
- University of Erlangen-Nuremberg
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Essen、ドイツ、45147
- Universitätsklinikum Essen
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Hannover、ドイツ、30625
- Hannover Medical School
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Jena、ドイツ、07747
- Universitatsklinikum Jena
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Köln、ドイツ、51109
- Kliniken der Stadt Koln gGmbH
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München、ドイツ、81377
- Ludwig-Maximilians-Universitätsklinik München
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Adult patients with a kidney or combined kidney/pancreas transplantation
- Unexplained renal allograft dysfunction within the first year of transplantation
- Renal allograft biopsy, which is clinically indicated to verify or exclude an acute rejection
Exclusion Criteria:
- Lacking consent of the patient to participate in the study
研究計画
研究はどのように設計されていますか？
デザインの詳細
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Ability of the urine mass spectrometry test to diagnose acute renal allograft rejection, compared to the gold standard 'allograft biopsy'
時間枠：Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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In patients with unexplained renal allograft dysfunction who get an allograft biopsy to clarify if an acute rejection is present, a simultaneous urine sample will be taken. The peptide pattern of this urine sample is analyzed by mass spectrometry and a diagnosis is made (rejection present/not present) based on a pre-defined peptide pattern which was established to detect acute allograft rejection. In the primary outcome analysis, the sensitivity and specificity of the rejection diagnosis by the urine test is compared to the diagnosis made by the allograft biopsy. |
Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Sensitivity and specificity of the urine test to diagnose acute renal allograft rejection in subgroups with different severity grades of the rejection
時間枠：Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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Sensitivity/specificity measures for the urine test will be determined in subgroups of patients with different severity of the rejection.
Severity grading is based on the pathomorphological classification of the rejection (according to the BANFF classification) and on the functional impairment of the allograft at the time of rejection diagnosis.
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Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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Sensitivity and specificity of the urine test to diagnose acute renal allograft rejection in subgroups with kidney transplantation alone and with combined pancreas/kidney transplantation
時間枠：Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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Sensitivity/specificity measures for the urine test will be determined in subgroups of patients who have a kidney transplant or a combined pancreas/kidney transplant.
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Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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Sensitivity and specificity of the urine test to diagnose acute renal allograft rejection in subgroups with concurrent infection
時間枠：Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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Sensitivity/specificity measures for the urine test will be determined in subgroups of patients who have concurrent infections at the time of the biopsy and urine sampling such as cytomegaly virus, polyoma virus, and urinary tract infection.
The analysis intends to identify potential interference of these conditions with the urine mass spectrometry test.
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Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day)
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協力者と研究者
スポンサー
捜査官
- 主任研究者：Wilfried Gwinner, Prof. /MD、Hannover Medical School
出版物と役立つリンク
一般刊行物
- Wittke S, Haubitz M, Walden M, Rohde F, Schwarz A, Mengel M, Mischak H, Haller H, Gwinner W. Detection of acute tubulointerstitial rejection by proteomic analysis of urinary samples in renal transplant recipients. Am J Transplant. 2005 Oct;5(10):2479-88. doi: 10.1111/j.1600-6143.2005.01053.x.
- Metzger J, Chatzikyrkou C, Broecker V, Schiffer E, Jaensch L, Iphoefer A, Mengel M, Mullen W, Mischak H, Haller H, Gwinner W. Diagnosis of subclinical and clinical acute T-cell-mediated rejection in renal transplant patients by urinary proteome analysis. Proteomics Clin Appl. 2011 Jun;5(5-6):322-33. doi: 10.1002/prca.201000153. Epub 2011 Apr 29.
- Zapf A, Gwinner W, Karch A, Metzger J, Haller H, Koch A. Non-invasive diagnosis of acute rejection in renal transplant patients using mass spectrometry of urine samples - a multicentre phase 3 diagnostic accuracy study. BMC Nephrol. 2015 Sep 15;16:153. doi: 10.1186/s12882-015-0146-x.
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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