A Pilot Trial of Pediatric Liver Transplantation Without Steroids

NCT ID: NCT00694408

Last Updated: 2017-01-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

15 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-06-30

Study Completion Date

2011-08-31

Brief Summary

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Objective:

The overall objective is to investigate whether a steroid free immunosuppressive regimen is as safe and effective as a steroid containing regimen following pediatric liver transplantation and whether it promotes tolerance.

Detailed Description

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3.2 Research question

Is it possible to avoid the use of corticosteroids in pediatric liver transplantation?

3.3 Trial objectives

This will be a pilot study to

i) investigate to what degree a steroid free immunosuppressive regimen is as safe and effective as a steroid containing regimen following pediatric liver transplantation

ii) investigate the effect of a steroid free immunosuppressive regimen on lymphocyte function and donor-specific immune responsiveness following pediatric liver transplantation

iii) investigate the effect of a steroid free immunosuppressive regimen on expression of tissue markers of tolerance following pediatric liver transplantation

It is hoped that this pilot study will be used to develop a definitive multicentre study of a steroid free regimen.

Conditions

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Evidence of Liver Transplantation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Steroid immunosuppressive regimen

Freedom from rejection and safety in children undergoing paediatric liver transplant using steroid containing immunosuppression regimen post transplant. This group of patients will receive steroids in conjunction with other prescribed immunosuppressive agents. Intervention is use of methyl prednisolone, hydrocortisone, prednisolone as routine post transplant management

Group Type ACTIVE_COMPARATOR

methyl prednisolone, hydrocortisone, prednisolone

Intervention Type DRUG

Will be specific dependant on weight of patients

Steroid free immunosuppressive regimen

Freedom from rejection and safety in children undergoing paediatric liver transplant using steroid free immunosuppression regimen post transplant. The patients in this arm will receive immunosuppression but not steroids to compare with those treated with steroids to measure differences in rejection and safety of a steroid free immunosuppressive regimen. Intervention is omission of methyl prednisolone, hydrocortisone, prednisolone as routine post transplant management. No steroids will be used routinely in this arm

Group Type ACTIVE_COMPARATOR

No steroids

Intervention Type OTHER

Children undergoing primary liver transplant will receive monoclonal antibodies and tacrolimus as per protocol

Interventions

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methyl prednisolone, hydrocortisone, prednisolone

Will be specific dependant on weight of patients

Intervention Type DRUG

No steroids

Children undergoing primary liver transplant will receive monoclonal antibodies and tacrolimus as per protocol

Intervention Type OTHER

Other Intervention Names

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Methylprednisolone;Hydrocortisone;Prednisolone

Eligibility Criteria

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Inclusion Criteria

* Children undergoing primary isolated hepatic transplantation.
* Age \<=18 years
* Ability to provide informed consent

Exclusion Criteria

* Children undergoing retransplantation.
* Transplantation for Intestinal failure associated liver disease.
* Multi-organ transplantation.
* Transplantation for autoimmune liver disease.
* Transplantation for extra hepatic malignancy.
* Pre-existing need for oral steroids, or high dose inhaled steroids sufficient to require a steroid warning card.
Minimum Eligible Age

1 Day

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Roche Pharma AG

INDUSTRY

Sponsor Role collaborator

Birmingham Women's and Children's NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Patrick McKiernan, MRCP FRCPCH

Role: PRINCIPAL_INVESTIGATOR

Birmingham Children's Hospital

Locations

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Birmingham Children's Hospital

Birmingham, West Midlands, United Kingdom

Site Status

Countries

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United Kingdom

References

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Evans HM, McKiernan PJ, Kelly DA. Mycophenolate mofetil for renal dysfunction after pediatric liver transplantation. Transplantation. 2005 Jun 15;79(11):1575-80. doi: 10.1097/01.tp.0000163504.29054.3f.

Reference Type BACKGROUND
PMID: 15940048 (View on PubMed)

Yoshizawa A, Ito A, Li Y, Koshiba T, Sakaguchi S, Wood KJ, Tanaka K. The roles of CD25+CD4+ regulatory T cells in operational tolerance after living donor liver transplantation. Transplant Proc. 2005 Jan-Feb;37(1):37-9. doi: 10.1016/j.transproceed.2004.12.259.

Reference Type BACKGROUND
PMID: 15808539 (View on PubMed)

Hathaway M, Adams DH. Demonstration that donor-specific nonresponsiveness in human liver allograft recipients is both rare and transient. Transplantation. 2004 Apr 27;77(8):1246-52. doi: 10.1097/01.tp.0000121136.84965.35.

Reference Type BACKGROUND
PMID: 15114093 (View on PubMed)

Walsh PT, Taylor DK, Turka LA. Tregs and transplantation tolerance. J Clin Invest. 2004 Nov;114(10):1398-403. doi: 10.1172/JCI23238.

Reference Type BACKGROUND
PMID: 15545987 (View on PubMed)

Sarwal MM, Vidhun JR, Alexander SR, Satterwhite T, Millan M, Salvatierra O Jr. Continued superior outcomes with modification and lengthened follow-up of a steroid-avoidance pilot with extended daclizumab induction in pediatric renal transplantation. Transplantation. 2003 Nov 15;76(9):1331-9. doi: 10.1097/01.TP.0000092950.54184.67.

Reference Type BACKGROUND
PMID: 14627912 (View on PubMed)

Vidhun JR, Sarwal MM. Corticosteroid avoidance in pediatric renal transplantation. Pediatr Nephrol. 2005 Mar;20(3):418-26. doi: 10.1007/s00467-004-1786-4. Epub 2005 Feb 3.

Reference Type BACKGROUND
PMID: 15690189 (View on PubMed)

Leonard H, Hornung T, Parry G, Dark JH. Pediatric cardiac transplant: results using a steroid-free maintenance regimen. Pediatr Transplant. 2003 Feb;7(1):59-63. doi: 10.1034/j.1399-3046.2003.00014.x.

Reference Type BACKGROUND
PMID: 12581330 (View on PubMed)

Arora-Gupta N, Davies P, McKiernan P, Kelly DA. The effect of long-term calcineurin inhibitor therapy on renal function in children after liver transplantation. Pediatr Transplant. 2004 Apr;8(2):145-50. doi: 10.1046/j.1399-3046.2003.00132.x.

Reference Type BACKGROUND
PMID: 15049794 (View on PubMed)

Kelly D, Jara P, Rodeck B, Lykavieris P, Burdelski M, Becker M, Gridelli B, Boillot O, Manzanares J, Reding R. Tacrolimus and steroids versus ciclosporin microemulsion, steroids, and azathioprine in children undergoing liver transplantation: randomised European multicentre trial. Lancet. 2004 Sep 18-24;364(9439):1054-61. doi: 10.1016/S0140-6736(04)17060-8.

Reference Type BACKGROUND
PMID: 15380964 (View on PubMed)

Reding R, Gras J, Sokal E, Otte JB, Davies HF. Steroid-free liver transplantation in children. Lancet. 2003 Dec 20;362(9401):2068-70. doi: 10.1016/S0140-6736(03)15104-5.

Reference Type BACKGROUND
PMID: 14697809 (View on PubMed)

Other Identifiers

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SFPT/OL

Identifier Type: -

Identifier Source: org_study_id

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