Trial Outcomes & Findings for Study in Recipients of Renal Transplant Allograft to Evaluate the Impact of Two Immunosuppressive Regimens (NCT NCT01653847)

NCT ID: NCT01653847

Last Updated: 2021-03-02

Results Overview

Evaluate the change in regulatory T cell generation and review the relationship of the newly generated T cells with their function in the two maintenance immunosuppressive regimens at baseline, 3 and 12 months post-transplant.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

88 participants

Primary outcome timeframe

Baseline, 3 months, and 12 months post-transplant

Results posted on

2021-03-02

Participant Flow

Donor participants were considered to be enrolled but were not part of our outcome analysis because their participation was only on the basis of providing blood for testing the immune system of the recipients.

Donor participants were considered to be enrolled but were not part of our outcome analysis because their participation was only on the basis of providing blood for testing the immune system of the recipients.

Participant milestones

Participant milestones
Measure
Group 1: Tacrolimus With MMF.
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Overall Study
STARTED
20
20
Overall Study
COMPLETED
19
20
Overall Study
NOT COMPLETED
1
0

Reasons for withdrawal

Reasons for withdrawal
Measure
Group 1: Tacrolimus With MMF.
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Overall Study
Withdrawal by Subject
1
0

Baseline Characteristics

Study in Recipients of Renal Transplant Allograft to Evaluate the Impact of Two Immunosuppressive Regimens

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Group 1: Tacrolimus With MMF.
n=20 Participants
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 Participants
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Total
n=40 Participants
Total of all reporting groups
Age, Continuous
48.4 years
STANDARD_DEVIATION 13 • n=5 Participants
48.3 years
STANDARD_DEVIATION 16 • n=7 Participants
48.4 years
STANDARD_DEVIATION 14.5 • n=5 Participants
Sex: Female, Male
Female
4 Participants
n=5 Participants
7 Participants
n=7 Participants
11 Participants
n=5 Participants
Sex: Female, Male
Male
16 Participants
n=5 Participants
13 Participants
n=7 Participants
29 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
20 Participants
n=5 Participants
20 Participants
n=7 Participants
40 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
7 Participants
n=5 Participants
11 Participants
n=7 Participants
18 Participants
n=5 Participants
Race (NIH/OMB)
White
13 Participants
n=5 Participants
9 Participants
n=7 Participants
22 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Pre-Emptive Transplant (Prior to Dialysis)
7 Participants
n=5 Participants
6 Participants
n=7 Participants
13 Participants
n=5 Participants
Cause of End Stage Renal Disease
Hypertension
5 Participants
n=5 Participants
6 Participants
n=7 Participants
11 Participants
n=5 Participants
Cause of End Stage Renal Disease
Polycystic Kidney Disease
1 Participants
n=5 Participants
3 Participants
n=7 Participants
4 Participants
n=5 Participants
Cause of End Stage Renal Disease
Lupus
1 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
Cause of End Stage Renal Disease
Diabetes
10 Participants
n=5 Participants
5 Participants
n=7 Participants
15 Participants
n=5 Participants
Cause of End Stage Renal Disease
Unknown
5 Participants
n=5 Participants
5 Participants
n=7 Participants
10 Participants
n=5 Participants
Induction Therapy History
Alemtuzumab
20 Participants
n=5 Participants
19 Participants
n=7 Participants
39 Participants
n=5 Participants
Induction Therapy History
IL-2 Receptor Antagonist
0 Participants
n=5 Participants
1 Participants
n=7 Participants
1 Participants
n=5 Participants

PRIMARY outcome

Timeframe: Baseline, 3 months, and 12 months post-transplant

Population: The percentage of Treg cells in peripheral blood is shown below per group.

Evaluate the change in regulatory T cell generation and review the relationship of the newly generated T cells with their function in the two maintenance immunosuppressive regimens at baseline, 3 and 12 months post-transplant.

Outcome measures

Outcome measures
Measure
Group 1: Tacrolimus With MMF.
n=20 Participants
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 Participants
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Change in T Cell & B Cell Generation
Baseline
1.05 Mean % of Treg cells in peripheral blood
Standard Deviation 0.17
0.93 Mean % of Treg cells in peripheral blood
Standard Deviation 0.13
Change in T Cell & B Cell Generation
3 Months
0.8 Mean % of Treg cells in peripheral blood
Standard Deviation 0.19
1.12 Mean % of Treg cells in peripheral blood
Standard Deviation 0.13
Change in T Cell & B Cell Generation
12 Months
0.81 Mean % of Treg cells in peripheral blood
Standard Deviation 0.10
1.18 Mean % of Treg cells in peripheral blood
Standard Deviation 0.13

PRIMARY outcome

Timeframe: 3 months, 6 months, and 12 months post-transplant

Evaluate the change in graft function (as measured by GFR) at 12 months post-transplant from baseline.

Outcome measures

Outcome measures
Measure
Group 1: Tacrolimus With MMF.
n=19 Participants
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 Participants
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Change in Glomerular Filtration Rate (GFR)
3 months
63 ml/minutes per 1.73 meters^2
Standard Deviation 19
66 ml/minutes per 1.73 meters^2
Standard Deviation 22
Change in Glomerular Filtration Rate (GFR)
6 months
64 ml/minutes per 1.73 meters^2
Standard Deviation 19
64 ml/minutes per 1.73 meters^2
Standard Deviation 24
Change in Glomerular Filtration Rate (GFR)
12 months
65 ml/minutes per 1.73 meters^2
Standard Deviation 20
72 ml/minutes per 1.73 meters^2
Standard Deviation 21

SECONDARY outcome

Timeframe: baseline - 24 months post transplant

The number of patients who were alive at 2 years post transplant

Outcome measures

Outcome measures
Measure
Group 1: Tacrolimus With MMF.
n=20 Participants
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 Participants
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Patient Survival
20 Participants
20 Participants

SECONDARY outcome

Timeframe: 12 months post-transplant

The number of subjects with renal allograft survival.

Outcome measures

Outcome measures
Measure
Group 1: Tacrolimus With MMF.
n=20 Participants
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 Participants
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Renal Allograft Survival
20 Participants
20 Participants

SECONDARY outcome

Timeframe: 12 months post transplant

Number of subjects who experience acute rejection of the renal allograft.

Outcome measures

Outcome measures
Measure
Group 1: Tacrolimus With MMF.
n=20 Participants
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 Participants
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Acute Rejection
4 Participants
0 Participants

Adverse Events

Group 1: Tacrolimus With MMF.

Serious events: 0 serious events
Other events: 6 other events
Deaths: 0 deaths

Group 2: Tacrolimus With Everolimus

Serious events: 0 serious events
Other events: 8 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Group 1: Tacrolimus With MMF.
n=20 participants at risk
This group will receive a standard dose Tacrolimus and MMF. This will follow standard of care protocol at Northwestern Memorial Hospital's Comprehensive Transplant Center. Tacrolimus with MMF: Standard dose Tacrolimus and MMF. This will follow standard of care procedures at Northwestern Memorial Hospital's Comprehensive Transplant Center. MMF trough or area under the concentration time curve (AUC) shall not be used to adjust dosing. In this group, Tacrolimus will be initiated according to our practice. The Tacrolimus dose will be adjusted from day 3 on to achieve a target whole blood trough concentration of 8 ng/mL to 10 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be reduced to 6 ng/mL to 8 ng/mL. After month 6, the target level of Tacrolimus will be reduced to 4 ng/mL to 8 ng/mL.
Group 2: Tacrolimus With Everolimus
n=20 participants at risk
This group will receive a low dose Tacrolimus with concentration controlled Everolimus Group 2: Tacrolimus with Everolimus.: From day 5 on, the starting dose of Everolimus (0.75 mg bid) will be increased if the trough level is \< 3 ng/mL, or reduced if the trough level is \> 8 ng/mL. Tacrolimus will be initiated according to our practice. In this treatment arm, the Tacrolimus dose will be adjusted from day 3 on, to a target whole blood trough concentration of 4 ng/mL to 7 ng/mL. From month 2 until Month 6, the target Tacrolimus trough level will be 3 ng/mL to 6 ng/mL. After month 6, the Tacrolimus dose should be adjusted in order to achieve a target trough level of 2 ng/mL to 5 ng/mL. MMF dose will be initiated as 1 g b.i.d. (2 g/day). Adjustments should be made for adverse events including but not limited to gastrointestinal intolerance and a decrease in white blood cell (WBC).
Metabolism and nutrition disorders
Hypertriglyceridemia
5.0%
1/20 • 2 years
15.0%
3/20 • 2 years
Infections and infestations
Polyomavirus nephropathy
5.0%
1/20 • 2 years
0.00%
0/20 • 2 years
Blood and lymphatic system disorders
Neutropenia
5.0%
1/20 • 2 years
0.00%
0/20 • 2 years
Infections and infestations
Other Infection
15.0%
3/20 • 2 years
25.0%
5/20 • 2 years

Additional Information

Lorenzo Gallon, MD

Northwestern University

Phone: 312-695-4457

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place