Trial Outcomes & Findings for Combined Drug Approach to Prevent Ischemia-reperfusion Injury During Transplantation of Livers (CAPITL) (NCT NCT02251041)

NCT ID: NCT02251041

Last Updated: 2024-08-23

Results Overview

peak AST is defined as the highest value of serum AST within 72 hours following liver transplantation

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

143 participants

Primary outcome timeframe

within 72 hours following liver transplantation

Results posted on

2024-08-23

Participant Flow

Of 143 enrolled participants, 93 were randomized. Reasons for exclusion of enrolled participants was : * Patients deceased before transplantation (on waiting list) * Patients not eligible anymore for transplantation * Included in other clinical trials * Change from single liver transplantation to combined transplantation (liver-kidney)

Participant milestones

Participant milestones
Measure
Combined Drug Approach
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Overall Study
STARTED
53
40
Overall Study
COMPLETED
38
36
Overall Study
NOT COMPLETED
15
4

Reasons for withdrawal

Reasons for withdrawal
Measure
Combined Drug Approach
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Overall Study
Did not receive intervention
15
4

Baseline Characteristics

Race data were not collected from participants

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Combined Drug Approach
n=38 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controls
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Total
n=74 Participants
Total of all reporting groups
Age, Continuous
59 years
n=38 Participants
60 years
n=36 Participants
60 years
n=74 Participants
Sex: Female, Male
Female
10 Participants
n=38 Participants
11 Participants
n=36 Participants
21 Participants
n=74 Participants
Sex: Female, Male
Male
28 Participants
n=38 Participants
25 Participants
n=36 Participants
53 Participants
n=74 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race data were not collected from participants
Race (NIH/OMB)
Asian
0 Participants
Race data were not collected from participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race data were not collected from participants
Race (NIH/OMB)
Black or African American
0 Participants
Race data were not collected from participants
Race (NIH/OMB)
White
0 Participants
Race data were not collected from participants
Race (NIH/OMB)
More than one race
0 Participants
Race data were not collected from participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race data were not collected from participants
Donor age
57 years
n=38 Participants
59 years
n=36 Participants
59 years
n=74 Participants
Donor type
Donation after Brain Death
26 Participants
n=38 Participants
23 Participants
n=36 Participants
49 Participants
n=74 Participants
Donor type
Donation after Circulatory Death
12 Participants
n=38 Participants
13 Participants
n=36 Participants
25 Participants
n=74 Participants
Warm ischemia time if Donation after Circulatory Death
17 minutes
n=12 Participants • Only livers from Donation after Circulatory Death donors undergo (donor) warm ischemia. So this is only measured and reported in the DCD population (see donor type)
16 minutes
n=13 Participants • Only livers from Donation after Circulatory Death donors undergo (donor) warm ischemia. So this is only measured and reported in the DCD population (see donor type)
17 minutes
n=25 Participants • Only livers from Donation after Circulatory Death donors undergo (donor) warm ischemia. So this is only measured and reported in the DCD population (see donor type)
Intensive Care Unit Length of stay (donor)
3 days
n=38 Participants
4 days
n=36 Participants
4 days
n=74 Participants
Donor cause of death
Trauma
6 Participants
n=38 Participants
11 Participants
n=36 Participants
17 Participants
n=74 Participants
Donor cause of death
Cerebrovascular accident
20 Participants
n=38 Participants
11 Participants
n=36 Participants
31 Participants
n=74 Participants
Donor cause of death
Anoxia
0 Participants
n=38 Participants
2 Participants
n=36 Participants
2 Participants
n=74 Participants
Donor cause of death
Other
12 Participants
n=38 Participants
12 Participants
n=36 Participants
24 Participants
n=74 Participants
Type of preservation solution
HTK (Histidine-tryptophan-ketoglutarate)
6 Participants
n=38 Participants
5 Participants
n=36 Participants
11 Participants
n=74 Participants
Type of preservation solution
UW (University of Wisconsin)
7 Participants
n=38 Participants
5 Participants
n=36 Participants
12 Participants
n=74 Participants
Type of preservation solution
IGL-1 (Institut Georges Lopez-1)
25 Participants
n=38 Participants
25 Participants
n=36 Participants
50 Participants
n=74 Participants
Type of preservation solution
Other
0 Participants
n=38 Participants
1 Participants
n=36 Participants
1 Participants
n=74 Participants
Brain death duration
13.3 hours
n=26 Participants • The duration of brain death is only measured in Donation after Brain Death donors (see Donor type)
14.3 hours
n=23 Participants • The duration of brain death is only measured in Donation after Brain Death donors (see Donor type)
13.5 hours
n=49 Participants • The duration of brain death is only measured in Donation after Brain Death donors (see Donor type)
Donor hepatectomy duration
34.5 minutes
n=38 Participants
32.5 minutes
n=36 Participants
34 minutes
n=74 Participants
Cold ischemia time
5.8 hours
n=38 Participants
5.8 hours
n=36 Participants
5.8 hours
n=74 Participants
Model for End-Stage Liver Disease score (MELD)
13.2 score on a scale
n=38 Participants
13.8 score on a scale
n=36 Participants
13.6 score on a scale
n=74 Participants
Indication for liver transplant
Metabolic disease
4 participants
n=38 Participants
3 participants
n=36 Participants
7 participants
n=74 Participants
Indication for liver transplant
HCC
18 participants
n=38 Participants
12 participants
n=36 Participants
30 participants
n=74 Participants
Indication for liver transplant
Chronic liver disease
25 participants
n=38 Participants
18 participants
n=36 Participants
43 participants
n=74 Participants
Indication for liver transplant
Ethyl
23 participants
n=38 Participants
18 participants
n=36 Participants
41 participants
n=74 Participants
Indication for liver transplant
HBV
2 participants
n=38 Participants
0 participants
n=36 Participants
2 participants
n=74 Participants
Indication for liver transplant
HCV
2 participants
n=38 Participants
0 participants
n=36 Participants
2 participants
n=74 Participants
Indication for liver transplant
Cholestatic disease
4 participants
n=38 Participants
4 participants
n=36 Participants
8 participants
n=74 Participants
Indication for liver transplant
Nonalcoholic Steatohepatitis
2 participants
n=38 Participants
10 participants
n=36 Participants
12 participants
n=74 Participants
Indication for liver transplant
Cryptogenic
1 participants
n=38 Participants
0 participants
n=36 Participants
1 participants
n=74 Participants
Implantation duration
39.5 Minutes
n=38 Participants
38.5 Minutes
n=36 Participants
39.0 Minutes
n=74 Participants

PRIMARY outcome

Timeframe: within 72 hours following liver transplantation

peak AST is defined as the highest value of serum AST within 72 hours following liver transplantation

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Peak Aspartate Aminotransferase Within First 72h Post Transplant
1262.9 U/L
Interval 946.3 to 1685.4
1451.2 U/L
Interval 1087.4 to 1936.7

SECONDARY outcome

Timeframe: 3 and 12 months after liver transplantation

Population: Death-censored graft survival

graft loss at 3 and 12 months after liver transplantation

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Graft Loss
3-months
2 Participants
0 Participants
Graft Loss
12-months
3 Participants
0 Participants

SECONDARY outcome

Timeframe: 3 and 12 months after liver transplantation

recipient death at 3 and 12 months after liver transplantation

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Recipient Death
3 months
3 Participants
1 Participants
Recipient Death
12 months
4 Participants
3 Participants

SECONDARY outcome

Timeframe: within first 7 days

early graft dysfunction as defined by Olthoff

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Early Graft Dysfunction
13 Participants
17 Participants

SECONDARY outcome

Timeframe: within 12 months post transplantation

Biliary strictures are the narrowing of the intrahepatic or extrahepatic biliary ductal system. Here we report the number of participants developing biliary strictures within 12 months post transplantation by MRCP (magnetic resonance cholangiopancreatography)

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Number of Participants Developing Biliary Strictures
13 Participants
10 Participants

SECONDARY outcome

Timeframe: One hour post reperfusion

Ischemia Reperfusion Injury score 1h post reperfusion by using the Suzuki score and Monbaliu et al. The score ranges from 0 (no injury) to 4 (severe injury).

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=25 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=23 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Ischemia Reperfusion Injury Score
2 score
Interval 2.0 to 4.0
2 score
Interval 1.0 to 4.0

SECONDARY outcome

Timeframe: till 1 year after transplantation

a liver biopsy will be taken after transplantation and in case of clinical suspicion of acute rejection

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Graft Rejection
9 Participants
8 Participants

SECONDARY outcome

Timeframe: within 1 year after liver transplantation

The ranking of surgical complications will be done by using Clavien-Dindo classification Grade I Any deviation from the normal post-operative course not requiring surgical, endoscopic or radiological intervention. This includes the need for certain drugs (e.g. antiemetics, antipyretics, analgesics, diuretics and electrolytes), treatment with physiotherapy and wound infections that are opened at the bedside Grade II Complications requiring drug treatments other than those allowed for Grade I complications; this includes blood transfusion and total parenteral nutrition (TPN) Grade III Complications requiring surgical, endoscopic or radiological intervention Grade IV Life-threatening complications; this includes CNS complications (e.g. brain haemorrhage, ischaemic stroke, subarachnoid haemorrhage) which require intensive care, but excludes transient ischaemic attacks (TIAs) Grade V Death of the patient A severe surgical complication is defined as Grade III or higher.

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Patients With at Least 1 Severe Surgical Complications
10 Participants
8 Participants

SECONDARY outcome

Timeframe: 1 year

Non-anastomotic biliary stricture at 1 year

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=36 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Non-anastomotic Biliary Stricture
4 Participants
2 Participants

SECONDARY outcome

Timeframe: 48h

An acute kidney injury score of 1 indicates risk; 2, injury; and 3, failure. According to RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) Minimum score is 0 meaning there is no injury, maximum score is 3 meaning failure of the organ.

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=34 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=35 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Acute Kidney Injury Score
RIFLE 0
27 Participants
31 Participants
Acute Kidney Injury Score
RIFLE 1
4 Participants
1 Participants
Acute Kidney Injury Score
RIFLE 2
2 Participants
3 Participants
Acute Kidney Injury Score
RIFLE 3
1 Participants
0 Participants

SECONDARY outcome

Timeframe: first 5 minutes following graft reperfusion

Post-reperfusion syndrome defined as a 30% decrease of mean systemic blood pressure for more than 1 minute during the first 5 minutes following graft reperfusion

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=29 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=29 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Post-Reperfusion Syndrome
7 Participants
6 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: During hospital stay for liver transplantation

Intensive Care Unit stay immediately after liver transplantation (not after rehospitalization)

Outcome measures

Outcome measures
Measure
Combined Drug Approach
n=38 Participants
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 Participants
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Intensive Care Unit Length of Stay (Recipient)
3 Days
Interval 1.5 to 6.5
4 Days
Interval 2.5 to 7.0

Adverse Events

Combined Drug Approach

Serious events: 6 serious events
Other events: 33 other events
Deaths: 4 deaths

Controles

Serious events: 4 serious events
Other events: 31 other events
Deaths: 3 deaths

Serious adverse events

Serious adverse events
Measure
Combined Drug Approach
n=36 participants at risk
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 participants at risk
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
Surgical and medical procedures
General surgical complications
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Respiratory, thoracic and mediastinal disorders
Respiratory insufficiency
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Renal and urinary disorders
Kidney dysfunction
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
0.00%
0/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Infections and infestations
Bacterial infection
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
0.00%
0/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Cardiac disorders
Arrythmia
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
0.00%
0/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Surgical and medical procedures
Portal vein thrombosis
0.00%
0/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation

Other adverse events

Other adverse events
Measure
Combined Drug Approach
n=36 participants at risk
the group receives a combination of drugs Antithrombin-III Infliximab Apotransferrin Human recombinant erythropoietin C1-Inhibitor Glutathione Alfa-tocopherol Melatonin Epoprostenol
Controles
n=36 participants at risk
the group do not receive a combination of drugs, but a placebo (sodium chloride solution) Sodium chloride solution
General disorders
Post-operative delirium
25.0%
9/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
30.6%
11/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Renal and urinary disorders
Acute kidney injury
33.3%
12/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
25.0%
9/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Respiratory, thoracic and mediastinal disorders
Respiratory failure post-op
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
11.1%
4/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Renal and urinary disorders
Urinary tract infections
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
13.9%
5/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Endocrine disorders
De novo diabetes mellitus
8.3%
3/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Infections and infestations
Viral infections
16.7%
6/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Infections and infestations
Bacterial infections
44.4%
16/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
27.8%
10/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Infections and infestations
Fungal infection
8.3%
3/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
8.3%
3/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Blood and lymphatic system disorders
Thrombo-embolitic complications
0.00%
0/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Cardiac disorders
Cardiovascular events
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
16.7%
6/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
General disorders
Cerebrovascular events
0.00%
0/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
2.8%
1/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Hepatobiliary disorders
Organ specific complications
13.9%
5/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
16.7%
6/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Injury, poisoning and procedural complications
Surgical complications - arterial
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Injury, poisoning and procedural complications
Surgical complications portal
5.6%
2/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
8.3%
3/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Injury, poisoning and procedural complications
Surgical complications - general
61.1%
22/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
50.0%
18/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Hepatobiliary disorders
Biliary problems
16.7%
6/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
13.9%
5/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
Immune system disorders
Rejections
16.7%
6/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation
16.7%
6/36 • Adverse events were collected over the time frame of 1 year starting immediately after transplantation

Additional Information

Diethard Monbaliu

UZLeuven

Phone: +32 16 348727

Results disclosure agreements

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