GDT Vs ST for Pancreas Transplant Surgery

NCT ID: NCT01619904

Last Updated: 2015-12-03

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

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-11-30

Study Completion Date

2015-03-31

Brief Summary

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A Pancreas Transplant is the accepted treatment in patients with Insulin Dependent Diabetes Mellitus (IDDM) and end-organ failure. Simultaneous Pancreas and Kidney (SPK) Transplant is done in over 90% of cases. At present there is a 5- 8% 30-day mortality with over 80% graft survival at 1 year. At Manchester Royal Infirmary (MRI) approximately 40 cases are done per year.

Goal-Directed Therapy (GDT) involves fluid resuscitation intra-operatively and early in the post-operative period, guided by cardiac output monitoring. The mechanism of therapeutic benefit is thought to be related to improved tissue oxygenation and oxygen delivery. There are a number of studies showing significantly improved biochemical markers of inflammation in animal models and in studies on septic patients (patients with an overwhelming infection) following GDT. Studies have also shown that GDT improves clinical outcome in post-operative patients and in serum inflammatory mediators. These studies have looked at "major abdominal surgery" but none have investigated transplant patients. Given the nature of surgery we feel that our patients would benefit with reduced Intensive Care Unit stay, reduced length of hospital stays and reduced rates of post-operative complications.

The study will be conducted on all adult patients undergoing pancreas transplant at MRI. It will last for 2 years and we hope to recruit 60 patients

Patients will be randomised into Standard Therapy (ST) or GDT groups, with ST being current practice. Each intervention will last for six hours post-operatively before continuing with normal care thereafter. Omental fat biopsies will be taken from patients intra-operatively and blood samples will be taken from patients at regular intervals for 72 hours intra- and post- operatively. Patients will be followed up daily while an in-patient and at three-monthly intervals in out-patients for 1 year.

Detailed Description

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Conditions

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Pancreas 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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Goal-Directed Therapy

Group Type EXPERIMENTAL

Goal-Directed Therapy

Intervention Type PROCEDURE

Peri-operative optimisation of fluid status, based on Oxygen Delivery

Standard Therapy

Group Type ACTIVE_COMPARATOR

Standard Therapy

Intervention Type PROCEDURE

Following standard protocol during peri-operative period

Interventions

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Goal-Directed Therapy

Peri-operative optimisation of fluid status, based on Oxygen Delivery

Intervention Type PROCEDURE

Standard Therapy

Following standard protocol during peri-operative period

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* All adult pancreas transplant recipients between November 2011- November 2013

Exclusion Criteria

* Those unable to consent
* Paediatric recipients
* Patients unable to meet follow-up protocol
* Patients with a contra-indication to central venous catheterisation
* Patients with advanced directives, restricting the implementation of the study protocol
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Manchester University NHS Foundation Trust

OTHER_GOV

Sponsor Role collaborator

University of Manchester

OTHER

Sponsor Role lead

Responsible Party

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Hussein Khambalia

Senior Clinical Research Fellow

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hussein A Khambalia, BMBS

Role: PRINCIPAL_INVESTIGATOR

CMFT, University of Manchester

Locations

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Manchester Royal Infirmary

Manchester, Manchester, United Kingdom

Site Status

Countries

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United Kingdom

Other Identifiers

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HAK 14

Identifier Type: -

Identifier Source: org_study_id