Ignite Creation Date:
2024-05-05 @ 11:24 AM
Last Modification Date:
2024-10-26 @ 9:06 AM
Study NCT ID:
NCT00023231
Status:
COMPLETED
Last Update Posted:
2016-10-21
First Post:
2001-08-29
Brief Title:
Pediatric Kidney Transplant Without Calcineurin Inhibitors
Sponsor:
National Institute of Allergy and Infectious Diseases NIAID
Organization:
National Institute of Allergy and Infectious Diseases NIAID
Study Overview
Official Title:
Calcineurin Inhibitor Sparing Protocol in Living Donor Pediatric Kidney Transplantation
Status:
COMPLETED
Status Verified Date:
2016-10
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:
The purpose of this study is to see the effect of using drugs other than calcineurin inhibitors to improve the rate of kidney transplant failure
Kidney transplantation can help children with end-stage kidney disease However it has been difficult to find treatment for donor graft rejection that does not have a lot of side effects Researchers hope to find treatments immunosuppressants with fewer side effects One approach is to avoid using calcineurin inhibitors and to try a new drug known as sirolimus instead Another is to use steroids less often This study will test whether using sirolimus fewer steroid treatments MMF and certain antibodies will improve long-term graft survival in children receiving kidney transplants from living donors
Kidney transplantation can help children with end-stage kidney disease However it has been difficult to find treatment for donor graft rejection that does not have a lot of side effects Researchers hope to find treatments immunosuppressants with fewer side effects One approach is to avoid using calcineurin inhibitors and to try a new drug known as sirolimus instead Another is to use steroids less often This study will test whether using sirolimus fewer steroid treatments MMF and certain antibodies will improve long-term graft survival in children receiving kidney transplants from living donors
Detailed Description:
Renal transplantation is widely recognized as the treatment of choice for children with end-stage renal disease ESRD Although outcomes of renal transplantation in children have improved during the past decade success has been limited by both non-specific tolerance and the complications associated with immunosuppressants Steroids and calcineurin inhibitors have the most toxic side effects Use of sirolimus for immunosuppression has not been associated with as many complications Recent studies from Europe have demonstrated that sirolimus can be combined with MMF and steroids to provide excellent graft survival in the absence of calcineurin inhibitors Steroid side-effects can be lessened by tapering the steroid dose to an every-other-day schedule This protocol tests whether immunosuppression by IL-2r antibody sirolimus MMF and alternate-day steroids will provide comparable graft survival for living donor recipients compared to current immunosuppression but with reduced complications of calcineurin inhibitors
Evaluations prior to transplantation include a complete history and physical examination CBC liver function tests and antibodies for CMV EBV HIV HbsAG and HCV All appropriate vaccinations are provided before transplantation Transplant recipients receive immunosuppression therapy using antibody induction daclizumab corticosteroids mycophenolate mofetil and sirolimus Serum sirolimus levels are measured so that doses can be adjusted to maintain certain blood levels of the drug Bactrim and ganciclovir are given for infection prophylaxis If the patient has consistent high levels of fasting cholesterol treatment with lipitor may be given A transplant biopsy is performed at the time of the transplant and at 3 6 and 12 months post transplantation and at times when a rejection is suspected A radionuclide GFR is done at the same time points and at 1 24 and 36 months The protocol biopsies blood and urine samples will be analyzed by genomic methods to determine differences in gene expression post transplantation In the event of a first acute rejection patients are treated with Solu-Medrol for 3 consecutive days A second rejection at the discretion of the transplant center or severe rejection Banff Grade 3 is treated with antibody therapy and after a second or severe rejection the immunosuppressant regimen is changed Patients are followed for 36 months with routine physical examinations and laboratory assessments
Evaluations prior to transplantation include a complete history and physical examination CBC liver function tests and antibodies for CMV EBV HIV HbsAG and HCV All appropriate vaccinations are provided before transplantation Transplant recipients receive immunosuppression therapy using antibody induction daclizumab corticosteroids mycophenolate mofetil and sirolimus Serum sirolimus levels are measured so that doses can be adjusted to maintain certain blood levels of the drug Bactrim and ganciclovir are given for infection prophylaxis If the patient has consistent high levels of fasting cholesterol treatment with lipitor may be given A transplant biopsy is performed at the time of the transplant and at 3 6 and 12 months post transplantation and at times when a rejection is suspected A radionuclide GFR is done at the same time points and at 1 24 and 36 months The protocol biopsies blood and urine samples will be analyzed by genomic methods to determine differences in gene expression post transplantation In the event of a first acute rejection patients are treated with Solu-Medrol for 3 consecutive days A second rejection at the discretion of the transplant center or severe rejection Banff Grade 3 is treated with antibody therapy and after a second or severe rejection the immunosuppressant regimen is changed Patients are followed for 36 months with routine physical examinations and laboratory assessments
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 |
|---|---|---|---|
| CN01 | None | None | None |