Trial to Define the Benefits and Harms of Deceased Donor Kidney Procurement Biopsies

NCT ID: NCT03837522

Last Updated: 2023-03-30

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

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-17

Study Completion Date

2023-02-04

Brief Summary

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The purpose of this research study is to compare the impact of the availability of biopsy results at the time of organ offers on the use and outcomes of kidneys from deceased donors.

Detailed Description

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Randomization of biopsy processing will be performed at the level of the deceased donor.

If the participant agrees to be in this study and signs the informed consent, at the time that a kidney is accepted for them, the accepted deceased donor will be randomized, like a flip of a coin, to one of two groups.

* Group 1: biopsies will be processed immediately (routine "frozen section") and results will be available to clinical teams at the time of the organ offers. Frozen section refers to a process where tissue from the biopsy sample is prepared by freezing and then slicing the tissue sample. Importantly, it can be done in about 15 to 20 minutes. Frozen sections are done when an immediate answer is needed; however, the quality of the sample is not always optimal.
* Group 2: biopsies will be processed using "permanent sections" - these results will not be available until after the organ is transplanted. Permanent section refers to a process where tissue from the biopsy sample is prepared by placing the tissue sample in a fixative, called formalin, to preserve the tissue, processing it through other additional solutions, and then placing it in paraffin wax. After the wax hardens, the tissue is cut into very thin slices, which are placed on slides and stained. This process normally takes several days.

There is a 50/50 chance that the donor will be randomized to immediate biopsy processing by frozen section, versus permanent processing that yields results after transplant. If for any reason their surgeon feels that it would not be safe to proceed without the biopsy result, he or she will have the ability to receive the results of the biopsy before the transplant. The study team will record any episodes of this occurrence.

Conditions

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Kidney Transplant Renal Transplant

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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Procurement Biopsy: Frozen section

In the routine care condition, biopsies will be processed immediately as a frozen section.

Group Type ACTIVE_COMPARATOR

Procurement Biopsy: Frozen section

Intervention Type DIAGNOSTIC_TEST

Frozen sections are prepared by freezing and slicing the tissue sample; importantly, they can be done in about 15 to 20 minutes. Frozen sections are done when an immediate answer is needed, but do not provide optimal quality.

Procurement Biopsy: Permanent section

In the intervention group, the biopsy processing will be delayed to permanent section, and therefore not available until allocation is complete.

Group Type ACTIVE_COMPARATOR

Procurement Biopsy: Permanent section

Intervention Type DIAGNOSTIC_TEST

Permanent sections are prepared by placing the tissue in fixative (usually formalin) to preserve the tissue, processing it through additional solutions, and then placing it in paraffin wax. After the wax has hardened, the tissue is cut into very thin slices, which are placed on slides and stained. The process normally takes several days.

Interventions

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Procurement Biopsy: Frozen section

Frozen sections are prepared by freezing and slicing the tissue sample; importantly, they can be done in about 15 to 20 minutes. Frozen sections are done when an immediate answer is needed, but do not provide optimal quality.

Intervention Type DIAGNOSTIC_TEST

Procurement Biopsy: Permanent section

Permanent sections are prepared by placing the tissue in fixative (usually formalin) to preserve the tissue, processing it through additional solutions, and then placing it in paraffin wax. After the wax has hardened, the tissue is cut into very thin slices, which are placed on slides and stained. The process normally takes several days.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Immediate results Delayed results

Eligibility Criteria

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Inclusion Criteria

* Kidney transplant candidate
* On waitlist for kidney transplant at the time of informed consent at one of the participating sites
* Age 18 or older
* Willing and able to provide informed consent for participation in the study

Exclusion Criteria

* Unable or unwilling to provide informed consent to participate in the study
* Younger than 18 years old
* Not on waitlist for kidney transplant at the time of informed consent at one of the participating centers
* Candidates for or recipients of multi-organ transplants (kidney along with another solid organ)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mid-America Transplant

OTHER

Sponsor Role collaborator

Washington University School of Medicine

OTHER

Sponsor Role collaborator

St. Louis University

OTHER

Sponsor Role lead

Responsible Party

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Krista Lentine MD, PhD

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Krista Lentine, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

St. Louis University

Locations

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Saint Louis University

St Louis, Missouri, United States

Site Status

Washington University

St Louis, Missouri, United States

Site Status

Countries

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United States

References

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Cooper M, Formica R, Friedewald J, Hirose R, O'Connor K, Mohan S, Schold J, Axelrod D, Pastan S. Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards. Clin Transplant. 2019 Jan;33(1):e13419. doi: 10.1111/ctr.13419. Epub 2018 Oct 21.

Reference Type BACKGROUND
PMID: 30345720 (View on PubMed)

Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review. Am J Transplant. 2015 Jul;15(7):1903-14. doi: 10.1111/ajt.13213. Epub 2015 Mar 13.

Reference Type BACKGROUND
PMID: 25772854 (View on PubMed)

Naesens M. Zero-Time Renal Transplant Biopsies: A Comprehensive Review. Transplantation. 2016 Jul;100(7):1425-39. doi: 10.1097/TP.0000000000001018.

Reference Type BACKGROUND
PMID: 26599490 (View on PubMed)

Hart A, Smith JM, Skeans MA, Gustafson SK, Stewart DE, Cherikh WS, Wainright JL, Kucheryavaya A, Woodbury M, Snyder JJ, Kasiske BL, Israni AK. OPTN/SRTR 2015 Annual Data Report: Kidney. Am J Transplant. 2017 Jan;17 Suppl 1(Suppl 1):21-116. doi: 10.1111/ajt.14124.

Reference Type BACKGROUND
PMID: 28052609 (View on PubMed)

De Vusser K, Lerut E, Kuypers D, Vanrenterghem Y, Jochmans I, Monbaliu D, Pirenne J, Naesens M. The predictive value of kidney allograft baseline biopsies for long-term graft survival. J Am Soc Nephrol. 2013 Nov;24(11):1913-23. doi: 10.1681/ASN.2012111081. Epub 2013 Aug 15.

Reference Type BACKGROUND
PMID: 23949799 (View on PubMed)

Kasiske BL, Stewart DE, Bista BR, Salkowski N, Snyder JJ, Israni AK, Crary GS, Rosendale JD, Matas AJ, Delmonico FL. The role of procurement biopsies in acceptance decisions for kidneys retrieved for transplant. Clin J Am Soc Nephrol. 2014 Mar;9(3):562-71. doi: 10.2215/CJN.07610713. Epub 2014 Feb 20.

Reference Type BACKGROUND
PMID: 24558053 (View on PubMed)

Husain SA, Chiles MC, Lee S, Pastan SO, Patzer RE, Tanriover B, Ratner LE, Mohan S. Characteristics and Performance of Unilateral Kidney Transplants from Deceased Donors. Clin J Am Soc Nephrol. 2018 Jan 6;13(1):118-127. doi: 10.2215/CJN.06550617. Epub 2017 Dec 7.

Reference Type BACKGROUND
PMID: 29217537 (View on PubMed)

Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Robinson A, Wainright JL, Haynes CR, Snyder JJ, Kasiske BL, Israni AK. OPTN/SRTR 2016 Annual Data Report: Kidney. Am J Transplant. 2018 Jan;18 Suppl 1(Suppl 1):18-113. doi: 10.1111/ajt.14557.

Reference Type BACKGROUND
PMID: 29292608 (View on PubMed)

Walker PD, Cavallo T, Bonsib SM; Ad Hoc Committee on Renal Biopsy Guidelines of the Renal Pathology Society. Practice guidelines for the renal biopsy. Mod Pathol. 2004 Dec;17(12):1555-63. doi: 10.1038/modpathol.3800239.

Reference Type BACKGROUND
PMID: 15272280 (View on PubMed)

Lentine KL, Kasiske B, Axelrod DA. Procurement Biopsies in Kidney Transplantation: More Information May Not Lead to Better Decisions. J Am Soc Nephrol. 2021 Aug;32(8):1835-1837. doi: 10.1681/ASN.2021030403. Epub 2021 May 27. No abstract available.

Reference Type DERIVED
PMID: 34045315 (View on PubMed)

Related Links

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https://www.kidney.org/newsletter/board-to-board/progress-discarding-kidney-can-discard-life

National Kidney Foundation. Progress: Discarding a kidney can discard a life. Overview of Consensus Conference to Decrease Kidney Discards.

http://statistics.eurotransplant.org

Eurotransplant Statistics Report Library.

Other Identifiers

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29880

Identifier Type: -

Identifier Source: org_study_id

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