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Remote Ischemic Preconditioning In Abdominal Organ Transplantation (RIPCOT)

Primary Purpose

Kidney Disease, Liver Disease, Pancreas Disease

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
RIPC by Inflation of Pneumatic Tourniquet
Sponsored by
University of Medicine and Dentistry of New Jersey
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Kidney Disease focused on measuring Remote ischemic preconditioning, deceased organ donors, ischemia reperfusion injury, Delayed graft function, Clinical outcomes in kidney transplant recipients, Clinical outcomes in liver transplant recipients, Clinical outcomes in pancreas transplant recipients

Eligibility Criteria

5 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • All deceased organ donors aged > 5 years in acute care hospitals in the donor service area of the New Jersey Organ and Tissue Sharing Network (NJTO).

DONORS

Exclusion Criteria:

  • Tissue only donors
  • Age < 5 years
  • When it is known before organ recovery that both kidneys will be leaving New Jersey. This may happen in a few instances either because of excellent tissue match with recipients outside New Jersey or in high risk behavior donors where all NJ kidney transplant centers have declined donor kidneys before organ recovery
  • Deceased donors in whom a decision is made not to recover both kidneys (severe kidney disease, renal failure, etc)
  • Severe trauma to both lower extremities precluding induction of RIPC

RECIPIENTS - KIDNEY

Inclusion Criteria:

  • Patients who receive a kidney from an enrolled donor at one of the five kidney transplant centers in New Jersey, HUH, NBIMC, SBMC, RWJUH and OLMC. No kidney recipients will be enrolled at UH because UH does not perform isolated kidney transplantation.

Exclusion Criteria :

  • All live donor kidney transplants performed at participating kidney transplant centers
  • Recipients of deceased donor kidneys imported from outside NJTO
  • Recipients of kidneys from deceased donors < 5 years of age
  • Recipients of combined liver and kidney transplantation, which are performed only at UH and OLMC. The numbers of such transplants are very few per year (<5). Also, the clinical and pathophysiological issues are different from those requiring isolated kidney transplantation
  • Recipients of en bloc (both kidneys together into one recipient) kidney transplantation from study donors. It is anticipated that such instances will be very few per year (<5)
  • Recipients of kidneys from deceased donors not enrolled in the study due to logistical reasons.

RECIPIENTS - LIVER

Inclusion Criteria:

  • All recipients of livers from deceased donors enrolled in this study and who receive their transplants at either of the two liver transplant centers in New Jersey, UH or OLMC.

Exclusion Criteria:

  • Live donor recipients
  • Recipients of livers imported from outside NJTO
  • Recipients of deceased donor livers from donors < 5 years of age
  • Recipients of livers from deceased donors not enrolled in the study due to logistical reasons

RECIPIENTS - PANCREAS

Inclusion Criteria:

  • All recipients of solid organ pancreas (isolated pancreas transplant or combined kidney pancreas transplant) from deceased donors enrolled in this study and who receive their transplants at one of the four pancreas transplant centers in New Jersey, HUH, SBMC, RWJUH and OLMC. NBIMC and UH do not perform pancreas transplantation

Exclusion Criteria

  • Islet cell transplant recipients
  • Recipients of deceased donor whole organ pancreas imported from outside NJ
  • Recipients of pancreas from deceased donors < 5 years of age
  • Recipients of pancreata from deceased donors not enrolled in the study due to logistical reasons

Sites / Locations

  • University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

No RIPC Group

RIPC Group

Arm Description

This group is the control group or the comparator group with RIPC

In this group deceased donors will receive Remote Ischemic Preconditioning (RIPC) by Inflation of Pneumatic Tourniquet of the lower limb prior to organ recovery.

Outcomes

Primary Outcome Measures

Organ Recovery
Organs Recovered and Transplanted per donor

Secondary Outcome Measures

Full Information

First Posted
September 10, 2009
Last Updated
January 13, 2015
Sponsor
University of Medicine and Dentistry of New Jersey
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1. Study Identification

Unique Protocol Identification Number
NCT00975702
Brief Title
Remote Ischemic Preconditioning In Abdominal Organ Transplantation
Acronym
RIPCOT
Official Title
Phase III Study of Efficacy of Remote Ischemic Preconditioning in Improving Outcomes in Organ Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
January 2015
Overall Recruitment Status
Completed
Study Start Date
April 2009 (undefined)
Primary Completion Date
December 2010 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Medicine and Dentistry of New Jersey

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Does remote ischemic preconditioning (RIPC) induced by a brief period of occlusion of blood flow to the lower extremity prior to organ recovery in deceased donors, improve short and long term outcomes after transplantation of kidneys, livers and pancreas? To test this hypothesis deceased organ donors will be randomized to receive either RIPC or No RIPC before organ recovery. RIPC will be induced in the operating room after commencement of procurement surgery. RIPC will be induced by tourniquet-induced occlusion of blood flow to the lower extremity for 10 minutes in each side, for a total duration of 20 minutes. The remainder of the organ recovery and organ preservation will be as per standard of practice. Recovered livers, kidneys and pancreas will be transplanted into allocated recipients. Transplantation and patient management after transplantation will be as per standard of practice. Organ-specific function and cell injury parameters will be utilized to assess the early postoperative outcomes of individual organs and recipients. Long term outcomes will be assessed by graft and recipient survival.
Detailed Description
Deceased organ donors and recipients of kidneys, livers and pancreata from the study donors comprise the study subjects. I. DONORS I. A. Inclusion Criteria All deceased organ donors aged > 5 years in acute care hospitals in the donor service area of the New Jersey Organ and Tissue Sharing Network (NJTO). I.B. Exclusion criteria Tissue only donors Age < 5 years When it is known before organ recovery that both kidneys will be leaving New JerseyIntervention: RIPC will be induced by inflation of a tourniquet around the upper thigh to 200 mm of Hg for a period of 10 minutes. After tourniquet deflation on one side, a similar procedure will be followed immediately on the opposite side. Thus, a total period of 20 minutes of lower extremity vascular occlusion will be utilized to induce RIPC. In instances of severe trauma to one lower extremity precluding tourniquet use, we will employ two cycles of 10 minutes of tourniquet occlusion in the non-traumatized lower extremity with 10 min of reperfusion in between. RIPC will be induced after commencement of procurement surgery but completed 30-45 min before circulatory arrest and initiation of organ perfusion. Additionally, liver biopsies (a wedge measuring 0.75 x 0.75 cm and a Tru-cut needle biopsy from the right lobe) are performed in as soon as the abdomen is opened. A wedge (1 x 0.3 cm) kidney biopsy is performed in all donors after kidney recovery but before packing the organs. All biopsies except kidney biopsies in donors aged < 50 years, are as per standard of care. The remainder of organ recovery, organ packaging and preservation are as per standard of practice. All kidneys recovered from donors classified as Extended Criteria Donors (donor age > 60 years or age 50-59 years with two of the following three criteria- cerebrovascular cause of death, a history of hypertension, terminal serum creatinine > 1.5 mg/dL) are routinely perfused ex-vivo in a pulsatile hypothermic perfusion apparatus until transplantation. . This may happen in a few instances either because of excellent tissue match with recipients outside New Jersey or in high risk behavior donors where all NJ kidney transplant centers have declined donor kidneys before organ recovery Deceased donors in whom a decision is made not to recover both kidneys (severe kidney disease, renal failure, etc) Severe trauma to both lower extremities precluding induction of RIPC

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Kidney Disease, Liver Disease, Pancreas Disease
Keywords
Remote ischemic preconditioning, deceased organ donors, ischemia reperfusion injury, Delayed graft function, Clinical outcomes in kidney transplant recipients, Clinical outcomes in liver transplant recipients, Clinical outcomes in pancreas transplant recipients

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
85 (Actual)

8. Arms, Groups, and Interventions

Arm Title
No RIPC Group
Arm Type
No Intervention
Arm Description
This group is the control group or the comparator group with RIPC
Arm Title
RIPC Group
Arm Type
Experimental
Arm Description
In this group deceased donors will receive Remote Ischemic Preconditioning (RIPC) by Inflation of Pneumatic Tourniquet of the lower limb prior to organ recovery.
Intervention Type
Procedure
Intervention Name(s)
RIPC by Inflation of Pneumatic Tourniquet
Intervention Description
Pneumatic tourniquets will be placed on both lower extremities in all deceased donor subjects. In the RIPC group the tourniquets will be inflated sequentially for 10 min each followed by deflation, approximately, 30-60 min prior to aortic crossclamping and organ perfusion.
Primary Outcome Measure Information:
Title
Organ Recovery
Description
Organs Recovered and Transplanted per donor
Time Frame
1 week

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All deceased organ donors aged > 5 years in acute care hospitals in the donor service area of the New Jersey Organ and Tissue Sharing Network (NJTO). DONORS Exclusion Criteria: Tissue only donors Age < 5 years When it is known before organ recovery that both kidneys will be leaving New Jersey. This may happen in a few instances either because of excellent tissue match with recipients outside New Jersey or in high risk behavior donors where all NJ kidney transplant centers have declined donor kidneys before organ recovery Deceased donors in whom a decision is made not to recover both kidneys (severe kidney disease, renal failure, etc) Severe trauma to both lower extremities precluding induction of RIPC RECIPIENTS - KIDNEY Inclusion Criteria: Patients who receive a kidney from an enrolled donor at one of the five kidney transplant centers in New Jersey, HUH, NBIMC, SBMC, RWJUH and OLMC. No kidney recipients will be enrolled at UH because UH does not perform isolated kidney transplantation. Exclusion Criteria : All live donor kidney transplants performed at participating kidney transplant centers Recipients of deceased donor kidneys imported from outside NJTO Recipients of kidneys from deceased donors < 5 years of age Recipients of combined liver and kidney transplantation, which are performed only at UH and OLMC. The numbers of such transplants are very few per year (<5). Also, the clinical and pathophysiological issues are different from those requiring isolated kidney transplantation Recipients of en bloc (both kidneys together into one recipient) kidney transplantation from study donors. It is anticipated that such instances will be very few per year (<5) Recipients of kidneys from deceased donors not enrolled in the study due to logistical reasons. RECIPIENTS - LIVER Inclusion Criteria: All recipients of livers from deceased donors enrolled in this study and who receive their transplants at either of the two liver transplant centers in New Jersey, UH or OLMC. Exclusion Criteria: Live donor recipients Recipients of livers imported from outside NJTO Recipients of deceased donor livers from donors < 5 years of age Recipients of livers from deceased donors not enrolled in the study due to logistical reasons RECIPIENTS - PANCREAS Inclusion Criteria: All recipients of solid organ pancreas (isolated pancreas transplant or combined kidney pancreas transplant) from deceased donors enrolled in this study and who receive their transplants at one of the four pancreas transplant centers in New Jersey, HUH, SBMC, RWJUH and OLMC. NBIMC and UH do not perform pancreas transplantation Exclusion Criteria Islet cell transplant recipients Recipients of deceased donor whole organ pancreas imported from outside NJ Recipients of pancreas from deceased donors < 5 years of age Recipients of pancreata from deceased donors not enrolled in the study due to logistical reasons
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Baburao Koneru, M.D.
Organizational Affiliation
UMDNJ-New Jersey Medical School
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital
City
Newark
State/Province
New Jersey
ZIP/Postal Code
07101
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
17846333
Citation
Ali ZA, Callaghan CJ, Lim E, Ali AA, Nouraei SA, Akthar AM, Boyle JR, Varty K, Kharbanda RK, Dutka DP, Gaunt ME. Remote ischemic preconditioning reduces myocardial and renal injury after elective abdominal aortic aneurysm repair: a randomized controlled trial. Circulation. 2007 Sep 11;116(11 Suppl):I98-105. doi: 10.1161/circulationaha.106.679167.
Results Reference
background
PubMed Identifier
17713425
Citation
Kanoria S, Jalan R, Seifalian AM, Williams R, Davidson BR. Protocols and mechanisms for remote ischemic preconditioning: a novel method for reducing ischemia reperfusion injury. Transplantation. 2007 Aug 27;84(4):445-58. doi: 10.1097/01.tp.0000228235.55419.e8.
Results Reference
background
PubMed Identifier
16750696
Citation
Cheung MM, Kharbanda RK, Konstantinov IE, Shimizu M, Frndova H, Li J, Holtby HM, Cox PN, Smallhorn JF, Van Arsdell GS, Redington AN. Randomized controlled trial of the effects of remote ischemic preconditioning on children undergoing cardiac surgery: first clinical application in humans. J Am Coll Cardiol. 2006 Jun 6;47(11):2277-82. doi: 10.1016/j.jacc.2006.01.066. Epub 2006 May 15.
Results Reference
background
PubMed Identifier
19188504
Citation
Hoole SP, Heck PM, Sharples L, Khan SN, Duehmke R, Densem CG, Clarke SC, Shapiro LM, Schofield PM, O'Sullivan M, Dutka DP. Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial. Circulation. 2009 Feb 17;119(6):820-7. doi: 10.1161/CIRCULATIONAHA.108.809723. Epub 2009 Feb 2.
Results Reference
background
PubMed Identifier
17707752
Citation
Hausenloy DJ, Mwamure PK, Venugopal V, Harris J, Barnard M, Grundy E, Ashley E, Vichare S, Di Salvo C, Kolvekar S, Hayward M, Keogh B, MacAllister RJ, Yellon DM. Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet. 2007 Aug 18;370(9587):575-9. doi: 10.1016/S0140-6736(07)61296-3.
Results Reference
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Remote Ischemic Preconditioning In Abdominal Organ Transplantation

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