Reduced Immunosuppression in Older Renal Transplant Recipients With Trugraf®/TRAC Monitoring (RIOT Trial): A Prospective, Randomized, Multicenter Trial.

NCT ID: NCT06568549

Last Updated: 2025-11-12

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

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

350 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-13

Study Completion Date

2031-03-31

Brief Summary

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The purpose of this research is to determine the safety and efficacy of withdrawing MMF (Mycophenolate Mofetil) in kidney transplant recipients who are 55 years or older at the time of receiving a kidney transplant. We are comparing them to patients who receive the standard of care Mycophenolate Mofetil.

Detailed Description

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Participation will be two years and it involves blood collection, collection of medical information and images from standard of care kidney biopsies. Subjects will be asked to complete questionnaires for the study at 12 and 24 months after kidney transplant. The research blood tests that are being collected for the study are called Trugraf®, Eurofins TRAC®, Trac-ID and Immunophenotyping and Single Cell RNA -sequencing. The principal investigator is using this test to see if they can predict and monitor rejection and viral infections in our kidney transplant patients. Immunophenotyping and single cell RNA sequencing tests are being done to identify unique gene expression profiles and their functions in different immune cells.

At the time of the 4 month standard of care kidney biopsy, if participants have not experienced any rejection episodes or formed any donor specific antibodies (dnDSA) and are still eligible, randomization will occur. Participants will be put into 1 of 2 groups: Mycophenolate Mofetil Maintenance group where the subject would continue on current medication, or the subject will be placed into the MMF Withdrawal group which means they would slowly be withdrawn from this medication. If the subject is not eligible to be randomized, they will remain in the study and placed into the Non-Randomized group and continue to have study related visits and procedures like the MMF Maintenance group.

Conditions

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Kidney Transplantation Mycophenolate Mofetil

Keywords

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Kidney Transplant

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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Non-Randomized Group

Individuals who do not meet eligibility for randomization will continue in the study and continue to follow study related visits. Individuals will continue with their current immunosuppression medication.

Group Type NO_INTERVENTION

No interventions assigned to this group

MMF Maintenance Group

Individuals randomized to the MMF Maintenance Group will not be withdrawn from their MMF and will continue to follow their standard of care immunosuppression medications.

Group Type ACTIVE_COMPARATOR

Mycophenolate Mofetil (MMF) Maintenance Group

Intervention Type DRUG

Mycophenolate Mofetil (MMF), administered orally as standard of care post kidney transplant as part of their immunosuppression regimen. Maintenance in Immunosuppression medication.

MMF Withdrawal Group

Individuals randomized to the MMF Maintenance Group will be withdrawn from their MMF immunosuppression medication from Month 4 to Month 10 post-transplant.

Group Type EXPERIMENTAL

Mycophenolate Mofetil (MMF) Withdrawal Group

Intervention Type DRUG

Mycophenolate Mofetil (MMF), administered orally as standard of care post kidney transplant as part of their immunosuppression regimen. Withdrawal of MMF immunosuppression medication.

Interventions

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Mycophenolate Mofetil (MMF) Maintenance Group

Mycophenolate Mofetil (MMF), administered orally as standard of care post kidney transplant as part of their immunosuppression regimen. Maintenance in Immunosuppression medication.

Intervention Type DRUG

Mycophenolate Mofetil (MMF) Withdrawal Group

Mycophenolate Mofetil (MMF), administered orally as standard of care post kidney transplant as part of their immunosuppression regimen. Withdrawal of MMF immunosuppression medication.

Intervention Type DRUG

Other Intervention Names

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CellCept CellCept

Eligibility Criteria

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Inclusion Criteria

* Solitary kidney transplant recipient \>55 years of age. At most 1 prior solitary kidney transplant.
* No other solid organ transplant though recipients of autologous stem cell transplants are eligible.
* HIV negative.
* Subjects must be on tacrolimus and mycophenolate mofetil or Myfortic at the time of consent. Prednisone at the time of consent is optional and is per local standard of care. Patients randomized to MMF withdrawal will be placed on prednisone 5mg/d at 4 months. Use of other immunosuppression medications for maintenance (cyclosporine, azathioprine, belatacept, sirolimus) is excluded.

Exclusion Criteria

* The results of the most recent DSA testing indicate DSA with an MFI \>2000.
* The results of the most recent cPRA testing indicate cPRA is above \>80% (based on MFI \>2000).
* Has a history of an underlying clinically significant acute or chronic medical condition or physical examination findings which, in the opinion of the investigator, would make study participation not in the participants best interest (e.g. compromises their well-being) or that could prevent, or limit the protocol specified assessment.

* Acute rejection episode either clinical or on biopsy (greater than borderline). Subjects must not experience any type of rejection episodes from the time of transplant and must not show any signs of rejection (Cellular or Antibody mediated rejection, excluding borderline) at their 4-month standard of care biopsy Subjects experiencing rejection will not be eligible for randomization and MMF withdrawal.
* Subjects who are unable to undergo their 4-month standard of care kidney biopsy due to medical contraindications.
* De novo DSA
* Subjects who are not maintained on tacrolimus, mycophenolate mofetil of Myfortic. Subjects who are not on tacrolimus and mycophenolate mofetil or Myfortic at the time of randomization will be placed in the non-randomized group.
* Has a history of an underlying clinically significant acute or chronic medical condition or physical examination findings which, in the opinion of the investigator, would make study participation not in the participants best interest (e.g., compromise the well-being) or that could prevent, or limit the protocol-specified assessment.
Minimum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Transplant Genomics, Inc.

INDUSTRY

Sponsor Role collaborator

Eurofins

INDUSTRY

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Mark Stegall

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mark D Stegall, M.D.

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

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Mayo Clinic

Phoenix, Arizona, United States

Site Status RECRUITING

Mayo Clinic

Jacksonville, Florida, United States

Site Status RECRUITING

Mayo Clinic

Rochester, Minnesota, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Mollie J. Luhman

Role: CONTACT

Phone: 507-266-2812

Email: [email protected]

Nong Yowe Braaten

Role: CONTACT

Phone: 507-266-6893

Email: [email protected]

Facility Contacts

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Xavier Lopez

Role: primary

Fady Khorany

Role: backup

David A. Legaspi

Role: primary

Jessica Toukmehji

Role: backup

Mollie J Luhman

Role: primary

Nong Yowe Braaten

Role: backup

Other Identifiers

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24-002574

Identifier Type: -

Identifier Source: org_study_id