Hypothesis: * That B cell depletion, rather than reducing acute rejection, will allow minimisation of immunosuppression, which may lead to better graft survival. Aim: * To assess whether the addition of rituximab to a low-dose tacrolimus immunosuppression regime allows a reduction in steroid administration. Objectives: * To assess whether B cell depletion affects graft function, acute rejection and complication rates * To assess whether the T cell response to allotransplantation is impaired by B cell depletion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
375mg/m\^2, single dose given 2-4 weeks prior to transplantation
dose calculated to give levels of 3-7ng/ml
Mycophenylate mofetil 2g/day in divided doses
South West Transplant Centre
Plymouth, Devon, United Kingdom
East Kent Hospitals NHS Foundation Trust
Canterbury, Kent, United Kingdom
Glasgow Renal and Transplant Unit
Glasgow, United Kingdom
Guy's and St Thomas' NHS Foundation Trust
London, United Kingdom
Estimated GFR (calculated using the Cockcroft-Gault formula)
Time frame: 1 year
Biopsy proven acute rejection (based on Banff classification)
Time frame: 1, 2, 3, 4, 5 years
Allograft survival
Time frame: 1, 2, 3, 4, 5 years
Patient Survival
Time frame: 1, 2, 3, 4, 5 years
Infection rate
New episodes, including (but not restricted to) viral (e.g. CMV, EBV), bacterial (e.g. Urinary Tract Infections with details of causative organism) and fungal infections will be recorded at each assessment time-point.
Time frame: 1 year
Changes in B and T cell repertoire
Time frame: 1 year
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100mg hydrocortisone on the evening of the day of surgery and 2 further doses of hydrocortisone on day 1 post transplant.
Prednisolone 0.3mg/kg on day 2, 0.25mg/kg on day 3, 0.2mg/kg on day 4 and 0.16mg/kg on day 5. On day 6 they will receive 5mg prednisolone, and on day 7 none.
Reducing dose of prednisolone over at least 6 months. Subsequent steroid maintenance or withdrawal will be at the discretion of the patient's clinician.
Central Manchester University Hospitals NHS Foundation Trust
Manchester, United Kingdom
Sheffield Kidney Institute
Sheffield, United Kingdom