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Clonal Deletion on Living-Relative Donor Kidney Transplantation (DAWN)

Primary Purpose

Renal Transplantation, Uremia

Status
Unknown status
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
donor specific transfusion
MMF, Bortezomib
drugs added according to the immuno condition of the recipients
Sponsored by
Fuzhou General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Renal Transplantation focused on measuring clonal deletion, kidney transplantation

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Uremia patient of any race that is greater than or equal to 18 years of age but less than 60 years old
  2. Recipients of a kidney from a certifiable relative donor 18-60 years of age
  3. Patient is willing and capable of giving written informed consent for study participation and able to participate in the study for 12 months

Exclusion Criteria:

  1. Women who are pregnant, intend to become pregnant in the next 1 years, breastfeeding, or have a positive pregnancy test on enrollment or prior to study medication administration
  2. Patient with prior solid organ transplant or cell transplant (e.g. bone marrow or islet cell).
  3. Patient is deemed likely to have a second solid organ transplant or cell transplant (e.g. bone marrow or islet cell) in next 3 years
  4. Patient receiving a concurrent SOT (heart, liver, pancreas) or cell transplant (islet, bone marrow, stem cell)
  5. ABO incompatible donor recipient pair or CDC crossmatch positive transplant
  6. Sensitized patients (most recent anti-HLA Class I or II Panel Reactive Antibodies (PRA)>0% by a CDC-assay) or patients identified a high immunological risk by the transplant physician
  7. Donor with cardiac death (non-heart beating donor)
  8. Recipient CMV seronegative receiving a organ from a seropositive donor (CMV seromismatch)
  9. Donor OR Recipient are known hepatitis C antibody-positive or polymerase chain reaction (PCR) positive for hepatitis C
  10. Donors OR Recipient are known hepatitis B surface antigen-positive or PCR positive for hepatitis B AND recipient is HBV negative
  11. Patient and/or donors with known human immunodeficiency virus (HIV) infection
  12. Patient at risk for tuberculosis (TB) Current clinical, radiographic, or laboratory evidence of active or latent TB as determined by local standard of care

    History of active TB:

    Within the last 2 years, even if treated Greater than 2 years ago, unless there is documentation of adequate treatment according to locally accepted clinical practice Patient at risk of reactivation of TB precludes administration of conventional immunosuppression (as determined by investigator and based upon appropriate evaluation)

  13. Patient with any significant infection or other contraindication that would preclude transplant
  14. Patient with a history of hypercoaguable state
  15. Patient with a history of substance abuse (drugs or alcohol) within the past 6 months, or psychotic disorders that are not compatible with adequate study follow-up.
  16. Patient with active peptic ulcer disease (PUD), chronic diarrhea, or gastrointestinal malabsorption
  17. Patient with a history of cancer within the last 5 years (exception: non-melanoma skin cell cancers cured by local resection are permitted)
  18. Patient with a chest radiograph (no more than 2 months prior to randomization) consistent with an acute lung parenchymal process and malignancy
  19. Patient with a hypersensitivity to any study drugs
  20. Patient who have used any investigational drug within 30 days prior to the Day 1 visit
  21. . Patients with autoimmune disease or patient treated with immunosuppressive therapy (eg methotrexate, abatacept, etc) for indications such as autoimmune disease or patient with comorbidity to a degree that treatment with such agents is likely during the trial
  22. Prisoner or patient compulsorily detained (involuntarily incarcerated) for treatment or either a psychiatric or physical (e.g. infectious disease) illness

Sites / Locations

  • No. 156, Xi er huan RoadRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Donor specific transfusion

Clonal deletion

Drugs Added When Needed

Arm Description

Subjects with uremia will undergo donor specific transfusion before transplantation

Outcomes

Primary Outcome Measures

Dosage of immunosuppressants
Effectiveness of clonal deletion on reducing the dosage of immunosuppressants (calcineurin inhibitor plus mycophenolate, azothioprine, or sirolimus).

Secondary Outcome Measures

immune event
Time to immune event (acute rejection or DSA);
DSA
Proportion of patients who become positive for donor specific HLA antibodies post transplant
DGF
Incidence of delayed graft function (defined as need for post-transplant dialysis)
Renal function
Change in renal function as determined by estimated glomerular filtration rate and proteinuria (>1g) at 1 year post transplant
Survival
Allograft Survival at 1 year post transplant

Full Information

First Posted
August 2, 2011
Last Updated
August 19, 2011
Sponsor
Fuzhou General Hospital
Collaborators
Terasaki Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT01408797
Brief Title
Clonal Deletion on Living-Relative Donor Kidney Transplantation
Acronym
DAWN
Official Title
A Prospective, Open-Label, Pilot Study of Clonal Deletion on Living-Relative Donor Kidney Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
February 2011
Overall Recruitment Status
Unknown status
Study Start Date
March 2011 (undefined)
Primary Completion Date
March 2013 (Anticipated)
Study Completion Date
March 2013 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Fuzhou General Hospital
Collaborators
Terasaki Foundation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this trial is to determine if clonal deletion before kidney transplantation can effectively reduce the need for post transplant immunosuppression. The investigators will adapt a DAWN (Drugs (immunosuppressants) Added When Needed) treatment protocol to assess the effect of clonal deletion and closely monitor acute rejection, renal function, and graft survival. 15 patients eligible for the study as described below will be enrolled.
Detailed Description
The objective of this trial is to determine if clonal deletion can effectively reduce the need for post transplant immunosuppressive medicine. Emphasis will be placed on adverse events that are associated with clonal deletion. The investigators will assess whether DAWN (Drugs (immunosuppressants) Added When Needed) is feasible in living-relative donor kidney transplantation and the effectiveness of clonal deletion treatment on the rate of rejection, patient survival, and graft function from day 0 to 12 months after transplantation. Numbers of patients on single drug and dual therapy immunosuppression will be counted. Additionally, the investigators would assess time to immune event (rejection or antibody), the severity of acute rejection or antibody mediated rejection by Banff criteria, the incidence of delayed graft function (defined as the need for post-transplant dialysis), and the incidence of adverse events including infection, grade 3 and above non-hematologic toxicities, and grade 4 hematologic toxicities.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Renal Transplantation, Uremia
Keywords
clonal deletion, kidney transplantation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
15 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Donor specific transfusion
Arm Type
Experimental
Arm Description
Subjects with uremia will undergo donor specific transfusion before transplantation
Arm Title
Clonal deletion
Arm Type
Experimental
Arm Title
Drugs Added When Needed
Arm Type
Experimental
Intervention Type
Procedure
Intervention Name(s)
donor specific transfusion
Intervention Description
before transplantation,200mL of donor whole blood will be transfused to the recipient
Intervention Type
Drug
Intervention Name(s)
MMF, Bortezomib
Intervention Description
MMF and Bortezomib will be administered after donor specific transfusion
Intervention Type
Procedure
Intervention Name(s)
drugs added according to the immuno condition of the recipients
Intervention Description
drugs (corticosteroid, MMF and/or CNI) will be added according to the recipients immuno event and donor specific antibody
Primary Outcome Measure Information:
Title
Dosage of immunosuppressants
Description
Effectiveness of clonal deletion on reducing the dosage of immunosuppressants (calcineurin inhibitor plus mycophenolate, azothioprine, or sirolimus).
Time Frame
one year
Secondary Outcome Measure Information:
Title
immune event
Description
Time to immune event (acute rejection or DSA);
Time Frame
1 year
Title
DSA
Description
Proportion of patients who become positive for donor specific HLA antibodies post transplant
Time Frame
1 year
Title
DGF
Description
Incidence of delayed graft function (defined as need for post-transplant dialysis)
Time Frame
1 years
Title
Renal function
Description
Change in renal function as determined by estimated glomerular filtration rate and proteinuria (>1g) at 1 year post transplant
Time Frame
1 year
Title
Survival
Description
Allograft Survival at 1 year post transplant
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Uremia patient of any race that is greater than or equal to 18 years of age but less than 60 years old Recipients of a kidney from a certifiable relative donor 18-60 years of age Patient is willing and capable of giving written informed consent for study participation and able to participate in the study for 12 months Exclusion Criteria: Women who are pregnant, intend to become pregnant in the next 1 years, breastfeeding, or have a positive pregnancy test on enrollment or prior to study medication administration Patient with prior solid organ transplant or cell transplant (e.g. bone marrow or islet cell). Patient is deemed likely to have a second solid organ transplant or cell transplant (e.g. bone marrow or islet cell) in next 3 years Patient receiving a concurrent SOT (heart, liver, pancreas) or cell transplant (islet, bone marrow, stem cell) ABO incompatible donor recipient pair or CDC crossmatch positive transplant Sensitized patients (most recent anti-HLA Class I or II Panel Reactive Antibodies (PRA)>0% by a CDC-assay) or patients identified a high immunological risk by the transplant physician Donor with cardiac death (non-heart beating donor) Recipient CMV seronegative receiving a organ from a seropositive donor (CMV seromismatch) Donor OR Recipient are known hepatitis C antibody-positive or polymerase chain reaction (PCR) positive for hepatitis C Donors OR Recipient are known hepatitis B surface antigen-positive or PCR positive for hepatitis B AND recipient is HBV negative Patient and/or donors with known human immunodeficiency virus (HIV) infection Patient at risk for tuberculosis (TB) Current clinical, radiographic, or laboratory evidence of active or latent TB as determined by local standard of care History of active TB: Within the last 2 years, even if treated Greater than 2 years ago, unless there is documentation of adequate treatment according to locally accepted clinical practice Patient at risk of reactivation of TB precludes administration of conventional immunosuppression (as determined by investigator and based upon appropriate evaluation) Patient with any significant infection or other contraindication that would preclude transplant Patient with a history of hypercoaguable state Patient with a history of substance abuse (drugs or alcohol) within the past 6 months, or psychotic disorders that are not compatible with adequate study follow-up. Patient with active peptic ulcer disease (PUD), chronic diarrhea, or gastrointestinal malabsorption Patient with a history of cancer within the last 5 years (exception: non-melanoma skin cell cancers cured by local resection are permitted) Patient with a chest radiograph (no more than 2 months prior to randomization) consistent with an acute lung parenchymal process and malignancy Patient with a hypersensitivity to any study drugs Patient who have used any investigational drug within 30 days prior to the Day 1 visit . Patients with autoimmune disease or patient treated with immunosuppressive therapy (eg methotrexate, abatacept, etc) for indications such as autoimmune disease or patient with comorbidity to a degree that treatment with such agents is likely during the trial Prisoner or patient compulsorily detained (involuntarily incarcerated) for treatment or either a psychiatric or physical (e.g. infectious disease) illness
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tan Jianming, MD,PhD
Phone
8613375918000
Email
doctortjm@yahoo.com
First Name & Middle Initial & Last Name or Official Title & Degree
Gao Xia, MD
Phone
8615959165311
Email
gaojxia@yahoo.com.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tan Jianming, MD,PhD
Organizational Affiliation
Fuzhou General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
No. 156, Xi er huan Road
City
Fuzhou
State/Province
Fujian
ZIP/Postal Code
350025
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tan Jianming, MD,PhD
Phone
8613375918000
Email
doctortjm@yahoo.com
First Name & Middle Initial & Last Name & Degree
Gao Xia, MD
Phone
8615959165311
Email
gaojxia@yahoo.com.cn
First Name & Middle Initial & Last Name & Degree
Tan Jianming, MD,PhD
First Name & Middle Initial & Last Name & Degree
Gao Xia, MD

12. IPD Sharing Statement

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Clonal Deletion on Living-Relative Donor Kidney Transplantation

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