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Antibody and Delayed Cyclosporine versus Initial Cyclosporine Alone in Patients Receiving Kidney Transplants



Antibody and Delayed Cyclosporine versus Initial Cyclosporine Alone in Patients Receiving Kidney Transplants

For Condition: Chronic Allograft Nephropathy,Kidney Transplantation
Status: Completed
Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) ,
Synopsis: The purpose of this study is to see if kidney function can be improved during transplants by giving the drug Thymoglobulin with delayed cyclosporine treatment instead of initial cyclosporine treatment. There have been improvements for patients receiving kidney transplants, yet acute rejection is still a problem. This can lead to kidney failure over time. Patients whose graft fails to function properly in the first week after transplant do not do as well after 5 years as compared to patients without early problems. This study will see if Thymoglobulin, a drug that suppresses the immune system, will improve early graft function.
Details: While graft survival of post renal transplant has improved over the last decades, acute rejection remains a problem that clinical research has sought to minimize through improved strategies. Graft survival prognosis is significantly worsened in patients whose allografts exhibit delayed function and patients may require early dialysis. Data shows that cadaveric organ recipients requiring dialysis use in the first transplant week have a 5-year post-graft survival rate of 51 percent compared to 70 percent for those free of this complication. A recent evaluation of Thymoglobulin (a rabbit-derived polyclonal antibody; an immunosuppressant) suggests it is an effective agent worthy of further evaluation as induction therapy. This trial evaluates whether a decreased DGF is seen with an improved Day 90 graft function. Recipients of a first or second cadaver kidney transplant are randomized pre-transplant to 1 of 2 treatment groups. One group receives antibody therapy (Thymoglobulin) at the time of transplant and delayed cyclosporine therapy. The other group starts cyclosporine therapy at the time of transplant without Thymoglobulin. DGF is diagnosed by a less than 20 percent decrease in the serum creatinine levels in the first 24 hours post-transplant and/or the need for dialysis. Patients on the antibody arm receive additional antibody if they experience DGF. Biopsies are performed in all cases of suspected rejection and any patient with biopsy-confirmed acute cellular rejection receives treatment. Patients have regular examinations including blood tests and are evaluated for kidney function and incidence of complications for 24 months after the transplant. The trial endpoint of graft function encompasses graft survival and graft function as calculated by creatinine clearance.
Eligibility:
Study Type:  Interventional, Treatment
Minimum Age/Maximum Age: 21 Years/
Genders: Both
Protocol Entry Criteria: Inclusion Criteria Patients may be eligible for this study if they: - Are receiving a first or second kidney transplant. - Are at least 21 years old. - Understand the purposes and risks of the study and have given consent. - Agree to use an acceptable form of birth control for a year following transplant. Exclusion Criteria Patients will not be eligible for this study if they: - Have received a kidney transplant from a living donor. - Have had multiple organ transplants. - Are allergic to Thymoglobulin (contains a rabbit protein). - Are pregnant.
Total Enrollment: 350

Location and Contact Information:

Ilene Blechman-Krom
Rockville,  Maryland,  20850
United States
 


Additional Information:
Study ID Numbers:  DAIT DG01; 
Study Start Date: April 2000
Record last reviewed: September 2003
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00007787

Other Chronic Allograft Nephropathy Studies:
1. Antibody and Delayed Cyclosporine versus Initial Cyclosporine Alone in Patients Receiving Kidney Transplants

2. Angiotensin II Blockade

3. Prevention of Kidney Transplant Rejection

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Antibody and Delayed Cyclosporine versus Initial Cyclosporine Alone in Patients Receiving Kidney Transplants
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