The purpose of this study is to evaluate whether conversion to everolimus (Zortress®), allowing the elimination or reduction of calcineurin inhibitors, will reduce nephrotoxicity (measured by increased creatinine clearance) and lengthen overall graft (kidney transplant) survival (measured by 2-3 year graft survival).
The purpose of this study is to evaluate whether conversion to everolimus (Zortress®), allowing the elimination or reduction of calcineurin inhibitors, will reduce nephrotoxicity (measured by increased creatinine clearance) and lengthen overall graft (kidney transplant) survival (measured by 2-3 year graft survival). Among the worst of the long-term effects of chronic immunosuppression are the nephrotoxicity (toxic to kidney cells) of the calcineurin inhibitors and the myriad complications of steroids. This protocol evaluates the elimination or reduction of calcineurin inhibitors in a protocol that has already successfully eliminated the long-term use of steroids. A considerable need remains for safer therapeutic agents that inhibit T-cell activation (a white blood cell that attacks foreign cells as part of the immune response) via a calcineurin independent or reduced-dose mechanism of action.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
55
Immunosuppression drug intervention
University of Toledo, Health Science Campus
Toledo, Ohio, United States
Renal Function
Renal function in patients will be assessed using glomerular filtration rate (GFR) as measured by the Modified Diet Renal Disease (MDRD) estimation. Glomerular filtration is the process by which the kidneys filter the blood, removing excess wastes and fluids. Glomerular filtration rate (GFR) is a calculation that determines how well the blood is filtered by the kidneys, which is one way to measure remaining kidney function. GFR is also used to find the stage of chronic kidney disease. Glomerular filtration rate is usually calculated using a mathematical formula that compares a person's size, age, sex, and race to serum creatinine levels. The higher the GFR number, the better the kidney function; the lower the GFR number, the worse the kidney function. A GFR of 60 or higher is in the normal range. A GFR below 60 may mean kidney disease. A GFR of 15 or lower may mean kidney failure.
Time frame: 2 years
Graft Survival
Graft survival is defined as the percentage of kidney transplants still functioning at 2 years post baseline visit . One patient died of natural causes at 12 months with a functioning graft.
Time frame: 2 years
Biopsy Proven Acute Rejection
The percentage of patients with a treated biopsy-proven acute rejection (a co-primary endpoint) within the 2 year study time period
Time frame: 2 years
Patient Survival
Patient survival is defined as the percentage of patients still surviving at 2 years post baseline visit
Time frame: 2 years
Impaired Glucose Tolerance
The number of patients with impaired glucose tolerance as indicated by fasting blood glucose levels, Hemoglobin A1C (HgbA1C) levels and the need for hypoglycemic medications
Time frame: 2 years
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Proteinuria
The number of patients with proteinuria as defined by spot urine protein to creatinine ratio greater than 1.0
Time frame: 2 years
Lipid Levels
The number of patients with hyperlipidemia as defined by the development of new onset hyperlipidemia in the baseline negative patients and the number of baseline positive patients who required starting a new lipid-lowering medication or an increase in dose of their lipid-lowering medication over the course of the study
Time frame: 2 years
Mouth Ulcers
The number of patients with stomatitis/aphthous ulcer
Time frame: 2 years
Gastrointestinal Complaints
The number of patients with gastrointestinal complaints as indicated by abdominal pain, nausea, vomiting or diarrhea not accounted for by a specific episode of illness such as gastroenteritis
Time frame: 2 years
Leukopenia
The number of patients with leukopenia as indicated by white blood cell count less than 1.0, absolute neutrophil count less than 500 or the need for exogenous granulocyte stimulating factor administration
Time frame: 2 years
Thrombocytopenia
The number of patients with thrombocytopenia as defined by platelet count less than 50
Time frame: 2 years
Neurotoxicity
The number of patients with neurotoxicity as evidenced by incidence of new onset seizure activity or tremors
Time frame: 2 years
Pneumonitis
The number of patients with pneumonitis as demonstrated by lung inflammation symptoms such as shortness of breath and/or cough requiring clinical intervention and management
Time frame: 2 years
Cytomegalovirus
The number of patients with Incidence of cytomegalovirus infection as defined by need for hospitalization
Time frame: 2 years
Infection Requiring Hospitalization
The number of patients with serious infections as defined by need for hospitalization
Time frame: 2 years
BK Infection
The number of patients with BK infection as defined by blood titers requiring reduction in immunosuppressive dose
Time frame: 2 years
BK Nephropathy
The number of patients with BK nephropathy as defined by biopsy. Note that biopsies were not required as part of the study but were only done as part of the patient's standard of care if rejection was suspected (i.e. if the serum creatinine increased by 25% and was not associated with elevated tacrolimus levels or clinical signs of dehydration/illness to account for elevated creatinine)
Time frame: 2 years
Malignancies
The number of patients developing malignancies including post-transplant lymphoproliferative disorders
Time frame: 2 years
Cardiovascular Complications
The number of patients with cardiovascular complications as indicated by conditions such as dysrhythmias, coronary artery disease requiring intervention or myocardial infarction
Time frame: 2 years
Development of Donor Specific Antibody
The number of patients with incidence of development of donor specific antibody
Time frame: 2 years