Ignite Creation Date:
2024-05-05 @ 11:32 AM
Last Modification Date:
2024-10-26 @ 9:09 AM
Study NCT ID:
NCT00074516
Status:
COMPLETED
Last Update Posted:
2017-10-06
First Post:
2003-12-12
Brief Title:
Kidney Transplantation in Patients With Cystinosis
Sponsor:
National Institute of Diabetes and Digestive and Kidney Diseases NIDDK
Organization:
National Institutes of Health Clinical Center CC
Study Overview
Official Title:
Renal Transplantation in Recipients With Nephropathic Cystinosis
Status:
COMPLETED
Status Verified Date:
2014-06-11
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study will test the effectiveness of a combination of anti-rejection medicines in preventing complications typically seen in cystinosis patients undergoing kidney transplants Cystinosis is a rare disease affecting children that causes growth retardation and kidney failure Kidney transplant is the standard treatment for kidney failure in these patients followed by immunosuppression to prevent organ rejection The standard drug regimen for immunosuppression includes steroids which can lead to other serious complications This study will look at combination therapy that does not include steroids
Patients 7 years of age and older with cystinosis who are candidates for a kidney transplant at the National Institutes of Health Clinical Center may be eligible for this 5-year study Candidates will be screened with a medical history physical examination and blood tests
Participants will undergo the following tests and procedures
1 Kidney transplant Patients undergo kidney transplant surgery under general anesthesia
2 Central line placement A large intravenous catheter plastic tube or IV line is placed in a vein in the chest or neck under local anesthesia before the transplant surgery The line remains in place for some time during the hospitalization to administer immunosuppressive medications antibiotics and blood if needed The line is also used to collect blood samples
3 Leukapheresis This procedure for collecting white blood cells is done before the transplant The cells are studied to evaluate the patients immune system Whole blood is withdrawn through a catheter in an arm vein or through the central line and directed into a machine that separates the blood components by spinning The white cells are removed and the red cells and plasma are returned to the body
4 Immunosuppressive medication following transplantation
Adults receive thymoglobulin at the time of the transplant and for 3 days after surgery mycophenolate mofetil daily after the transplant tacrolimus twice a day once the kidney is working well and sirolimus daily
Children receive daclizumab the day of the transplant day 4 after surgery and at weeks 2 4 6 8 11 15 19 and 23 and mycophenolate mofetil daily after the transplant
5 Follow-up visits After discharge from the hospital patients return to the Clinical Center for follow-up at 6 months at 1 year and then yearly for 5 years A physical examination is done the first four visits and blood and urine samples are collected at every visit Kidney biopsies removal of a small amount of kidney tissue through a thin needle are done at 6 months 1 3 and 5 years after the transplant The biopsied tissue is examined to evaluate how well the kidney is responding to the immunosuppression medicines to determine whether more or less medication is needed and to evaluate how the patient is responding to the donor kidney
6 Routine laboratory tests coordinated by the patients local physician are done 2 to 3 times a week for the first 2 to 3 months after transplantation then weekly for several more months and at least monthly for life
Patients 7 years of age and older with cystinosis who are candidates for a kidney transplant at the National Institutes of Health Clinical Center may be eligible for this 5-year study Candidates will be screened with a medical history physical examination and blood tests
Participants will undergo the following tests and procedures
1 Kidney transplant Patients undergo kidney transplant surgery under general anesthesia
2 Central line placement A large intravenous catheter plastic tube or IV line is placed in a vein in the chest or neck under local anesthesia before the transplant surgery The line remains in place for some time during the hospitalization to administer immunosuppressive medications antibiotics and blood if needed The line is also used to collect blood samples
3 Leukapheresis This procedure for collecting white blood cells is done before the transplant The cells are studied to evaluate the patients immune system Whole blood is withdrawn through a catheter in an arm vein or through the central line and directed into a machine that separates the blood components by spinning The white cells are removed and the red cells and plasma are returned to the body
4 Immunosuppressive medication following transplantation
Adults receive thymoglobulin at the time of the transplant and for 3 days after surgery mycophenolate mofetil daily after the transplant tacrolimus twice a day once the kidney is working well and sirolimus daily
Children receive daclizumab the day of the transplant day 4 after surgery and at weeks 2 4 6 8 11 15 19 and 23 and mycophenolate mofetil daily after the transplant
5 Follow-up visits After discharge from the hospital patients return to the Clinical Center for follow-up at 6 months at 1 year and then yearly for 5 years A physical examination is done the first four visits and blood and urine samples are collected at every visit Kidney biopsies removal of a small amount of kidney tissue through a thin needle are done at 6 months 1 3 and 5 years after the transplant The biopsied tissue is examined to evaluate how well the kidney is responding to the immunosuppression medicines to determine whether more or less medication is needed and to evaluate how the patient is responding to the donor kidney
6 Routine laboratory tests coordinated by the patients local physician are done 2 to 3 times a week for the first 2 to 3 months after transplantation then weekly for several more months and at least monthly for life
Detailed Description:
Cystinosis is an autosomal recessive disorder due to impaired cystine transport across the lysosomal membrane resulting in abnormal cystine accumulation throughout the body Fanconi syndrome manifests in the first year of life and end-stage renal failure occurs at 10 years of age requiring dialysis or kidney transplantation Oral cysteamine therapy delays but does not always prevent the need for a renal allograft in cystinosis which accounts for 3 of all pediatric transplants in the United States With improvements in immunosuppression short-term graft and patient survival is quite good for cystinosis patients although not as good as for patients with ESRD due to structural defects Long-term graft survival can be affected by the non-renal complications of cystinosis which persist after renal transplantation
The aim of this study is to establish standards for the transplantation of kidneys into patients with nephropathic cystinosis using steroid-sparing immunosuppression Our goals are to
1 Analyze the long and short term outcome of cystinosis patients following living and cadaveric kidney transplantation using steroid-free immunosuppression
2 Determine a consistent clinical approach to recipients with cystinosis in the immediate post-operative period specifically regarding fluid and electrolyte management retention of native kidneys and timing of the re-initiation of cystinosis therapy after transplantation
3 Assess the immunologic impact of cystinosis by monitoring immune responses using a number of in vitro assays
In this study patients will receive a living donor or cadaveric kidney transplant with steroid free immunosuppression Graft function histology and graft and patient survival will be measured Progression of cystinosis in other organ systems will be monitored Additional studies on the graft will include transcriptional analysis of inflammatory and immunologic mediators Serum will be assayed for inflammatory mediators and peripheral white blood cells assayed for immune function This study will represent the first comprehensive prospective analysis of kidney transplantation in patients with cystinosis
The aim of this study is to establish standards for the transplantation of kidneys into patients with nephropathic cystinosis using steroid-sparing immunosuppression Our goals are to
1 Analyze the long and short term outcome of cystinosis patients following living and cadaveric kidney transplantation using steroid-free immunosuppression
2 Determine a consistent clinical approach to recipients with cystinosis in the immediate post-operative period specifically regarding fluid and electrolyte management retention of native kidneys and timing of the re-initiation of cystinosis therapy after transplantation
3 Assess the immunologic impact of cystinosis by monitoring immune responses using a number of in vitro assays
In this study patients will receive a living donor or cadaveric kidney transplant with steroid free immunosuppression Graft function histology and graft and patient survival will be measured Progression of cystinosis in other organ systems will be monitored Additional studies on the graft will include transcriptional analysis of inflammatory and immunologic mediators Serum will be assayed for inflammatory mediators and peripheral white blood cells assayed for immune function This study will represent the first comprehensive prospective analysis of kidney transplantation in patients with cystinosis
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 04-DK-0057 | None | None | None |