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NCT Number: NCT06676696

Study to Compare the Outcome of Receiving Continued Immunosuppression Versus Stopping Immunosuppression at 6 Months to Safely Prevent Human Leukocyte Antigen (HLA) Sensitization in Patients With Late Renal Graft Failure

The goal of this clinical trial is to compare the degree of HLA sensitization at 2 years in patients with late renal graft failure (> 3 months) when receiving reduced immunosuppressant treatment versus stopping immunosuppression at 6 months.

The main question this study aims to answer is:

Does maintaining long-term immunosuppression in patients with a late renal graft failure (> 3 months) safely reduce the risk of HLA sensitization?

To answer this question, patients will be assigned to a control arm or investigational arm:

* Patients assigned to the control arm will receive standard treatment, in which immunosuppressant treatment is withdrawn after 6 months. * Patients assigned to the investigatonal arm will continue immunosuppressant treatment at low doses for 2 years.

Patients recruited in this clinical trial will be followed for up to 2 years. During this time, patients will visit the clinic every 3 months for checkups and tests.

Recruiting

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Key information

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patient must be able to understand and provide written informed consent
  • Patients older than 18 years who had received at least one previous renal transplant
  • Patients with a retained kidney graft failed for any reason which survived at least 3 months
  • Patients on dialysis, either hemodialysis or peritoneal dialysis. Patients can be on dialysis for a maximum of 6 months at the time of randomization, as long as the patients have taken an uninterrupted immunosuppressive regimen of calcineurin inhibitors (tacrolimus or cyclosporine) and steroids since dialysis was restarted
  • Patients already relisted or candidates to relist to deceased donor kidney transplantation according to the treating physician criteria
  • Patients taking immunosuppressants tacrolimus or cyclosporine
  • cPRA at the time of randomization ≤ 90%

Exclusion criteria

  • Patients who have received another solid organ transplantation (liver, lung, heart or pancreas)
  • Patients waiting for a living related / unrelated kidney transplant
  • Graft survival of the failed graft lower than 3 months
  • Patients in dialysis more than 6 months at the time of randomization
  • Patients not accomplishing criteria to relist in the transplantation list according to the treating physician criteria
  • Pregnant women
  • Females of childbearing age who have not used or do not plan to use acceptable birth control measures, for the duration of the study. Patients should use one of the acceptable birth control measures recommended in the document "Recommendations related to contraception and pregnancy testing in clinical trials" published by the Clinical Trials Facilitation and Coordination Group (CTFG) (version 1.1, published 21/09/2020). Recommended birth control measures include oral, injected or implanted hormonal contraceptive, barrier methods (condom or diaphragm with spermicide), intrauterine device, surgical sterilization, transdermal delivery, or sexual abstinence. If sexually active, the subject must have been using one of the accepted birth control methods at least one month prior to study entry.

Treatment and study plan

Continue low dose calcineurin inhibitor (CNI)

Drug

CNI dose (tacrolimus or cyclosporine) will be adjusted to maintain low tacrolimus or cyclosporine whole blood trough levels from month 3 to month 24 or End of Study

Calcineurin inhibitor withdrawal at 6 months

Drug

CNI dose (tacrolimus or cyclosporine) will be reduced to one-half on month 3 visit and completely withdrawn on month 6 visit.

Primary outcomes

  1. Degree of HLA sensitization

    Time frame: 2 years

    The difference between the two treatment arms in the degree of HLA sensitization at 2-years measured as cPRA (%).

Secondary outcomes

  1. Mortality for any reason

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on mortality for any reason

  2. Days of hospitalization for any reason

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on days of hospitalization for any reason

  3. Percentage of patients effectively relisted during follow-up

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on percentage of patients effectively relisted during follow-up

  4. Percentage of patients transplanted

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on percentage of patients transplanted

  5. Percentage of patients delisted for any reason

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on percentage of patients delisted for any reason

  6. Incidence of infection

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on incidence of infection

  7. Incidence of cardiovascular events

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on incidence of cardiovascular events

  8. Incidence of cancer

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on incidence of cancer

  9. Incidence of graft-intolerance syndrome requiring graft nephrectomy or percutaneous embolization of the non-functioning graft

    Time frame: 2 years

    The difference between the two treatment arms at 2-years incidence of graft-intolerance syndrome requiring graft nephrectomy or percutaneous embolization of the non-functioning graft

  10. Erythropoietin resistance index

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on erythropoietin resistance index

  11. Residual renal function

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on residual renal function

  12. Number of circulating memory B-cells

    Time frame: 2 years

    The difference between the two treatment arms at 2-years on number of circulating memory B-cells

  13. Adverse events

    Time frame: 2 years

    The difference in the incidence of adverse events (AE) in the two treatment arms

Study contacts

Contact information is provided by the study sponsor or research team.

Francesc Moreso, MD, PhD

CONTACT

[email protected]

93 489 30 00

Sponsors and collaborators

Lead sponsor

Hospital Universitari Vall d'Hebron Research Institute

Other

Registry information

Official study title

A Multi-centre, Open, Prospective, Randomized, Parallel-group, 24-month Study to Compare the Outcome of Receiving Continued Immunosuppression Versus Stopping Immunosuppression at 6 Months to Safely Prevent Human Leukocyte Antigen (HLA) Sensitization in Patients With Late Renal Graft Failure

Important dates

Study start
2024
Primary completion
2028
Study completion
2028
First posted
Nov 6, 2024
Registry last updated
Nov 6, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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