This study will test whether selected allogeneic bone marrow derived MSCs are safe by assessing the composite end point Biopsy Proven Acute Rejection (BPAR)/ graft loss at 12 months.
Kidney transplantation has improved survival and quality of life for patients with end-stage renal disease. However, despite advances in immunosuppressive therapy, long-term allograft survival outcomes have not improved over the last decade. A promising novel therapeutic immunosuppressive option in the treatment of renal recipients with a profound effect on the fibrosis reaction is the clinical application of mesenchymal stromal cells (MSCs). Allogeneic MSCs offer the advantage of availability for clinical use without the delay required for expansion. Although it is believed that allo MSCs are immune privileged, they could possibly elicit an anti-donor immune response, which may increase the incidence of rejection/ graft loss and impact the allograft survival on the long term. These safety issues should be studied before further studies are planned with allogeneic MSCs in the transplant setting. MSCs are infused at a time point when immune suppression is lowered and the kidney is at increased risk for developing immune mediated injury. In addition, a large amount of the kidneys already has signs of fibrosis at this time point and MSCs might reduce the fibrosis which so importantly affects long term survival. MSCs will have no Human Leucocyte Antigen (HLA) sharing with the mismatches of the donor and the recipient should have no antibodies directed to the MSCs to reduce the anti-donor immune respons risk.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
2 doses of 1-2x10\^6 allogeneic bone marrow derives MSCs IV per/kg body weight at weeks 25 and 26 after transplantation
Leiden University Medical Center
Leiden, Netherlands
biopsy proven acute rejection / graft loss
Time frame: 12 months after transplantation
Comparison of fibrosis by quantitative Sirius Red scoring
Time frame: Before MSC infusion (week 24 after transplantation) and 6 months after MSC infusion (week 52 after transplantation)
Serious adverse events
Time frame: 12 months after transplantation
Renal function measured by cGFR (MDRD formula) and iohexol clearance
Time frame: week 24 after transplantation (before MSC infusion) and 52 after transplantation
CMV, BK infection (viremia, disease and syndrome; and subtypes of BK viremia) and other opportunistic infections
Time frame: from baseline up to 26 weeks after MSC treatment
Development of de novo donor specific antibodies (DSA) and immunological responses
Time frame: at baseline, week 24 after transplantation (before MSC treatment) up to week 26 after MSC treatment
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