Reference Group Trial for The ONE Study
End-stage Renal Failure, Kidney Graft Rejection
About this trial
This is an interventional basic science trial for End-stage Renal Failure focused on measuring gold standard treatment, immune monitoring, acute rejection, graft rejection, living-donor, renal transplantation, kidney transplantation
Eligibility Criteria
Inclusion Criteria:
Organ Donor:
A prospective donor is eligible for the research if all of the following inclusion criteria apply:
- Eligible for live kidney donation
- Aged at least 18 years
- An ABO blood type compatible with the organ recipient
- Willing and able to provide a blood sample for The ONE Study Subprojects
- Willing to provide personal and medical/biological data for the trial
- Signed and dated written informed consent.
In signing the donor information sheet/informed consent form (DIS/ICF), organ donors agree to provide a blood sample for the IM Subproject, and permit access to their medical records for the collection of specified demographic and medical/biological data for the trial.
Organ Recipient:
- Chronic renal insufficiency necessitating kidney transplantation and approved to receive a primary kidney allograft from a living donor
- Aged at least 18 years
- Able to commence the immunosuppressive regimen at the protocol-specified time point
- Willing and able to participate in The ONE Study subprojects
- Signed and dated written informed consent.
Exclusion Criteria:
Organ Donor:
If a prospective donor fulfils any of the following criteria, then they are ineligible for the trial:
- Genetically identical to the prospective organ recipient at the HLA loci
- Exposure to any investigational agents at the time of kidney donation, or within 28 days prior to kidney donation
- Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the Investigator, may invalidate communication with the Investigator and/or designated study personnel
- Subjects unable to freely give their informed consent (e.g. individuals under legal guardianship).
Organ Recipient:
- Patient has previously received, or is scheduled to receive, any tissue or organ transplant other than the planned kidney graft
- Known sensitivity to tacrolimus, mycophenolate, or corticosteroids
- Genetically identical to the prospective organ donor at the HLA loci
- PRA grade > 40% within 6 months prior to enrolment
- Previous treatment with any desensitisation procedure (with or without IVIg)
- Concomitant malignancy or history of malignancy within 5 years prior to planned study entry (excluding successfully-treated non-metastatic basal/squamous cell carcinoma of the skin)
- Evidence of significant local or systemic infection
- HIV-positive, EBV-negative or suffering chronic viral hepatitis
- Significant liver disease, defined as persistently elevated AST and/or ALT levels >2 x ULN (Upper Limit of Normal range)
- Malignant or pre-malignant haematological conditions
- Any uncontrolled medical condition or concurrent disease that could interfere with the study objectives
- Any condition which, in the judgement of the Investigator, would place the subject at undue risk
- Ongoing treatment with systemic immunosuppressive drugs at study entry
- Participation in another clinical trial during the study or within 28 days prior to planned study entry
- Female patients of child-bearing potential with a positive pregnancy test at enrolment
- Female patients who are breast-feeding
All female patients of child-bearing potential UNLESS:
- The patient is willing to maintain a highly effective method of birth control for the duration of the study
- The career, lifestyle, or sexual orientation of the patient ensures that there is no risk of pregnancy for the duration of the study (at the discretion of the local Investigator)
- Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up visit schedule
- Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the Investigator, may invalidate communication with the Investigator and/or designated study personnel
- Patients unable to freely give their informed consent (e.g. individuals under legal guardianship).
Sites / Locations
- University of California San Francisco
- Massachusetts General Hospital
- CHU de Nantes Hotel-Dieu
- Charite Campus Virchow-Klinikum
- University Hospital Regensburg
- Ospedale San Raffaele
- Guy's Hospital in affiliation with King's College London
- Churchill Hospital in affiliation with the University of Oxford
Arms of the Study
Arm 1
Other
Reference Group
Basiliximab (Simulect®): Day 0: 20mg IV ≤2h prior to surgery Day 4: 20mg IV Prednisolone: Day 0: 500mg IV (250mg pre-op, 250mg intra-op) Day 1: 125mg IV Day 2 - 14: 20mg/day oral Week 3 - 4: 15mg/day oral Week 5 - 8: 10mg/day oral Week 9 - 12: 5mg/day oral Week 13 - 14: 2.5mg/day oral Week 15 - Study End: Cessation Steroid tapering should not proceed if graft rejection has occurred or if renal dysfunction is observed. Mycophenolate Mofetil (MMF, or biologic equivalent): Treatment with MMF should commence one day prior to transplantation (on Day -1) and should continue indefinitely, with a dose reduction after two weeks: Day -1 - 14: 2g/day oral Day 15 - Study End 1.5g/day oral (750mg twice daily) Tacrolimus (or biologic equivalent): Day -4 - 14: 3-12ng/ml Week 3 - 12: 3-10ng/ml Week 13 - 36: 3-8ng/ml Week 37 - Study End: 3-6ng/ml