Belatacept Compared to Tacrolimus in Deceased Donor Renal Transplant Recipients

Columbia University57 enrolled

Overview

The main purpose of this study is to ﬁnd out whether treatment to prevent kidney rejection with belatacept in presence of Thymoglobulin induction and withdrawal of steroids will result in less delayed graft function or "sleepy kidney" after transplant than that seen in patients who get tacrolimus as their main drug to prevent rejection instead of belatacept. The investigators will also look at whether patients who get belatacept have the same, lesser or more problems that those who get tacrolimus.

New York Presbyterian Hospital-Columbia University Medical Center (NYPH-CUMC) performs nearly 250 renal transplants annually; of these approximately half are recipients of a variety of deceased donor kidneys, usually with cold ischemia time (CIT) \>24 hours leading to an approximate incidence of delayed graft function (DGF) of 50%. The main focus of this study will be to determine whether initial immunosuppression with belatacept with Thymoglobulin induction will result in lower incidence and/or more rapid disappearance of DGF than that observed in patients who receive tacrolimus based immunosuppression. NGAL determinations will bne made in the first months after transplantation to correlate with clinical DGF.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Implant or Graft; Rejection

Interventions

BelataceptDRUG

Belatacept 10 mg/kg will be administered in the operating room approximately 1 hour prior to kidney allograft reperfusion (Day 0). It will then be administered at 10 mg/kg on the following post-transplantation days: Day 5, 14, 30, 56, and 84. Belatacept 5 mg/kg will be administered every four weeks thereafter until end of study.

TacrolimusDRUG

Tacrolimus 0.05 mg/kg by mouth every 12 hours will be on Day 0 after transplantation. It will then be administered at 8-12 ng/mL on the following post-transplantation days: Day 3-90; at 8-10 ng/mL Day 91-180. Tacrolimus 6 - 8 ng/mL will be administered daily thereafter until end of study. (standard of care)

MycophenolateDRUG

An immunosuppressive agent used with other medicines to lower the body's natural immunity in patients who receive kidney transplants. 720 mg by mouth every 12 hours (Day 0)(1080 mg AA). (standard of care)

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients must have known Epstein-Barr virus (EBV) serostatus, and that status must be positive * Adult patients ≥18 years of age, receiving a deceased donor kidney transplant at Columbia University Medical Center (CUMC) * Patients with a PRA ≤ of 50 * Primary or re-transplant candidates (no more than 5th renal transplant) * Deceased donor renal transplant recipients * Candidates eligible for rATG induction * Patients fully consented prior to transplantation * Women of reproductive age who are willing to delay pregnancy for the duration of the study and use appropriate recommended contraception Exclusion Criteria: * Seronegative or unknown EBV serologic status (due to the risk of post-transplant lymphoproliferative disorder, PTLD), predominantly involving the central nervous system. * Patients with tuberculosis who have not been treated for latent infection. * Scheduled to undergo multi-organ transplantation * Recipients of previous non-renal organ transplant * Patient receiving 5th renal transplant at the time of screening. * Patients with a PRA \> 50 * Recipient is pre-emptive status. * Recipient with positive flow crossmatch. * History or known HIV * Known hypersensitivity or contra-indications to Belatacept, Tacrolimus, Mycophenolate mofetil (cellcept), or mycophenolic acid * Use of an investigational drug in the past 30 days before day of surgery * Enrolled in a clinical trial other than the current * Lactating or pregnant women * Donor specific antibodies (DSA) identified at the time of transplantation * ABO incompatible renal transplant

Locations (1)

Columbia University Medical Center

New York, New York, United States

Outcomes

Primary Outcomes

Number of Participants With Delayed Graft Function (DGF)

To assess whether treatment with Thymoglobulin induction and belatacept based maintenance immunosuppression would reduce delayed graft function (DGF) rates among recipients of deceased donor renal transplants as measured by clinical findings and NGAL marker, as specified below and defined by others. This will be compared to the incidence of DGF in patients treated with a Tacrolimus based regimen. Patients who require hemodialysis in the first 7 days after transplantation and/or patients whose serum creatinine decreases \<10% during 3 consecutive days after the transplant will be considered to have DGF in the absence of other confounding factors such as obstruction or infection. NGAL will be used as a verification marker of DGF.

Time frame: Up to 3 months post-transplantation

Secondary Outcomes

Percentage of Participants With Allograft Survival

Allograft survival is defined as functioning renal transplant.

Time frame: Up to 1 year post-transplantation

Number of Participants With an Allograft Rejection Episode

All rejection episodes will be confirmed by renal transplant biopsy provoked by change in renal function not explained by other clinical causes.

Time frame: Up to 1 year post-transplantation

Estimated Glomerular Filtration Rate (eGFR)

Estimated glomerular filtration rate (eGFR) is based on a blood sample (serum creatinine value), age, race, and gender. eGFR estimates best the function of the kidney at any one time.

Time frame: Up to 1 year post-transplantation

Data from ClinicalTrials.gov

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