The Role of ImmuKnow® in the Management of Immunosuppressants in the Renal Transplant Patient

NCT ID: NCT01424345

Last Updated: 2012-10-05

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

PHASE4

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-12-31

Study Completion Date

2012-07-31

Brief Summary

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The purpose of this study is to demonstrate whether there are any outcome benefits of a serial ImmuKnow assays in the management of de novo renal transplant recipients.

Detailed Description

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Background: The management of renal transplant recipients is challenging in keeping a delicate balance of immunosuppression to avoid either infection (overimmunosuppression), or rejection (under-immunosuppression). Conventional clinical parameters are not adequate enough. ImmuKnow (Cylex Inc, Columbia, MD) is an FDA-cleared assay for the detection of cell mediated immune response in populations undergoing immunosuppressive therapy for organ transplant. There have been limited retrospective studies discussing the effectiveness of the ImmuKnow assay. There is no prospective head-to-head trial showing the benefits of periodic ImmuKnow testing.

Objective: To demonstrate whether there are any outcome benefits of a serial ImmuKnow assays in de novo renal transplant recipients Patients and Methods: A prospective, randomized, pilot, controlled 12-month study to compare the outcomes of 2 cohorts of de novo renal transplant patients will be conducted. The outcomes that will be investigated include a combined infection rate (primary end-point), separate infection rates and episodes, acute rejection rate and episodes, quality of life, graft and patient survivals (all secondary end-points). Biopsy of the transplanted kidney is used to confirm rejection whenever possible. Among the study cohort, the patients' immunosuppressants will be adjusted according to the results of a serial ImmuKnow assay besides using conventional clinical parameters; whereas among the control cohort the patients' immunosuppressants will be adjusted according to conventional clinical parameters.

Expected Results: At the end of this study we will be able to learn whether the study cohort patients have less infection, less acute rejection, better allograft function, better quality of life, and better graft or patient survivals.

Conditions

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Kidney Transplant Immunosuppression

Keywords

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Kidney Transplantation Immunosuppression Immune monitoring

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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control group

Dosages of immunosuppressants will be given according to the results of conventional post-transplant lab

Group Type ACTIVE_COMPARATOR

adjustment of the dosages of immunosuppressants

Intervention Type DRUG

adjustment of the dosages of immunosuppressants will be done according to the results of conventional post-transplant follow-up lab

ImmuKnow Study group

The dosages of immunosuppressants will be adjusted according to the results of ImmuKnow and conventional post-transplant lab

Group Type EXPERIMENTAL

adjustment of immunosuppressant dosages

Intervention Type DRUG

adjustment of immunosuppressant dosages according to the results of ImmuKnow results and routine post-transplant lab results

Interventions

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adjustment of immunosuppressant dosages

adjustment of immunosuppressant dosages according to the results of ImmuKnow results and routine post-transplant lab results

Intervention Type DRUG

adjustment of the dosages of immunosuppressants

adjustment of the dosages of immunosuppressants will be done according to the results of conventional post-transplant follow-up lab

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. De novo kidney transplant patients who are eligible for kidney transplant according to UNOS criteria and agree to participate in the study.
2. Patients of both sex aged between 18 to 80 years.

Exclusion Criteria

* Any patient with a known immunocompromised disease (e.g. patients with AIDS) or leukocytosis(\>15,000u/L)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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CAMC Health System

OTHER

Sponsor Role lead

Responsible Party

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SC Jeff Chueh, MD

Primary Surgeon, UNOS, CAMC-WV kidney transplant program

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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S Jeff Chueh, MD PhD

Role: PRINCIPAL_INVESTIGATOR

CAMC Health System, Charleston, WV

Bashir Sankari, MD

Role: STUDY_DIRECTOR

CAMC Health System, Charleston, Wv

Locations

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CAMC

Charleston, West Virginia, United States

Site Status

Countries

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United States

References

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Kowalski RJ, Post DR, Mannon RB, Sebastian A, Wright HI, Sigle G, Burdick J, Elmagd KA, Zeevi A, Lopez-Cepero M, Daller JA, Gritsch HA, Reed EF, Jonsson J, Hawkins D, Britz JA. Assessing relative risks of infection and rejection: a meta-analysis using an immune function assay. Transplantation. 2006 Sep 15;82(5):663-8. doi: 10.1097/01.tp.0000234837.02126.70.

Reference Type BACKGROUND
PMID: 16969290 (View on PubMed)

Reinsmoen NL, Cornett KM, Kloehn R, Burnette AD, McHugh L, Flewellen BK, Matas A, Savik K. Pretransplant donor-specific and non-specific immune parameters associated with early acute rejection. Transplantation. 2008 Feb 15;85(3):462-70. doi: 10.1097/TP.0b013e3181612ead.

Reference Type BACKGROUND
PMID: 18301338 (View on PubMed)

Gautam A, Fischer SA, Yango AF, Gohh RY, Morrissey PE, Monaco AP. Cell mediated immunity (CMI) and post transplant viral infections--role of a functional immune assay to titrate immunosuppression. Int Immunopharmacol. 2006 Dec 20;6(13-14):2023-6. doi: 10.1016/j.intimp.2006.09.023. Epub 2006 Oct 24.

Reference Type BACKGROUND
PMID: 17161357 (View on PubMed)

Batal I, Zeevi A, Heider A, Girnita A, Basu A, Tan H, Shapiro R, Randhawa P. Measurements of global cell-mediated immunity in renal transplant recipients with BK virus reactivation. Am J Clin Pathol. 2008 Apr;129(4):587-91. doi: 10.1309/23YGPB1E758ECCFP.

Reference Type BACKGROUND
PMID: 18343786 (View on PubMed)

Sanchez-Velasco P, Rodrigo E, Valero R, Ruiz JC, Fernandez-Fresnedo G, Lopez-Hoyos M, Pinera C, Palomar R, Leyva-Cobian F, Arias M. Intracellular ATP concentrations of CD4 cells in kidney transplant patients with and without infection. Clin Transplant. 2008 Jan-Feb;22(1):55-60. doi: 10.1111/j.1399-0012.2007.00744.x.

Reference Type BACKGROUND
PMID: 18217906 (View on PubMed)

Kowalski R, Post D, Schneider MC, Britz J, Thomas J, Deierhoi M, Lobashevsky A, Redfield R, Schweitzer E, Heredia A, Reardon E, Davis C, Bentlejewski C, Fung J, Shapiro R, Zeevi A. Immune cell function testing: an adjunct to therapeutic drug monitoring in transplant patient management. Clin Transplant. 2003 Apr;17(2):77-88. doi: 10.1034/j.1399-0012.2003.00013.x.

Reference Type BACKGROUND
PMID: 12709071 (View on PubMed)

Kobashigawa JA, Kiyosaki KK, Patel JK, Kittleson MM, Kubak BM, Davis SN, Kawano MA, Ardehali AA. Benefit of immune monitoring in heart transplant patients using ATP production in activated lymphocytes. J Heart Lung Transplant. 2010 May;29(5):504-8. doi: 10.1016/j.healun.2009.12.015. Epub 2010 Feb 4.

Reference Type BACKGROUND
PMID: 20133166 (View on PubMed)

Huskey J, Gralla J, Wiseman AC. Single time point immune function assay (ImmuKnow) testing does not aid in the prediction of future opportunistic infections or acute rejection. Clin J Am Soc Nephrol. 2011 Feb;6(2):423-9. doi: 10.2215/CJN.04210510. Epub 2010 Nov 18.

Reference Type BACKGROUND
PMID: 21088287 (View on PubMed)

Knight RJ, Kerman RH, McKissick E, Lawless A, Podder H, Katz S, Van Buren CT, Kahan BD. Selective corticosteroid and calcineurin-inhibitor withdrawal after pancreas-kidney transplantation utilizing thymoglobulin induction and sirolimus maintenance therapy. Clin Transplant. 2008 Sep-Oct;22(5):645-50. doi: 10.1111/j.1399-0012.2008.00839.x. Epub 2008 Jul 24.

Reference Type BACKGROUND
PMID: 18657156 (View on PubMed)

John Ware, Jr, Ph.D., Mark Kosinski, M.A., James E. Dewey, Ph.D., Barbara Gandek, M.S. How to score & interpret single item health status measures. Manual for users of SF8, Lincdn, RI. Quality Metric Incorporated, 2001. 1998-2001

Reference Type BACKGROUND

1. ImmuKnow®® Cylex™ Immune Cell Function Assay, Package Insert (http://www.cylex.net/pdf/ImmuKnow_Insert-cx.pdf)

Reference Type RESULT

Other Identifiers

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1997050

Identifier Type: -

Identifier Source: org_study_id