Protocol Biopsies in High-risk Renal Transplant Recipients

Hospital de Clinicas de Porto Alegre119 enrolled

Overview

The present study aims to evaluate the usefulness of protocol biopsies in a cohort of renal transplant patients of high immunological risk for graft injury and loss.

This will be a prospective study undertaken at the Renal Transplant Unit of Hospital of Clinics of Porto Alegre. In addition to the routine evaluation commonly carried-out at this post-transplant period, protocol biopsies will be performed at the 10th-week post-transplantation in high-risk transplant recipients. Biopsy fragments will be evaluated for tissue immune aggression (mainly cellular and antibody-mediated rejections) and other conditions such as infections, particularly polyomavirus and cytomegalovirus and medication toxicities. The presence of donor-specific antibodies and graft-damaging infectious agents will also be searched in the peripheral blood at the time of biopsy.One hundred patients will be randomized to a protocol biopsy and noninvasive assessment or only for noninvasive assessment. The hypothesis of the study is that biopsies will lead to treatments that may allow better outcomes of renal transplants, related to lowering the progression of subclinical aggressions, avoiding or delaying graft loss and preserving or decreasing the rate of loss of the glomerular filtration rate. Therefore, this strategy has the possibility of reaching clinical practice routine and thus contribute positively to the management of renal transplant patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

119

Conditions

Kidney Transplant Rejection Kidney Transplant Failure Kidney Transplant Infection Kidney Transplant Failure and Rejection

Interventions

Percutaneous renal biopsy.PROCEDURE

The biopsy will be performed with a 16 Gauge semi-automatic needle gun for renal biopsy under real-time ultrasound control. After the procedure will be done ultrasound control

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: Adult kidney transplants, with high immunological risk, who consented to participate in the study by signing the informed consent form. The high immune risk is defined by: * Positive pre-transplant T-lymphocyte cross-test by flow cytometry (channel deviation greater than 62); * Flow cytometry pre-transplantation positive B lymphocyte cross-test (channel deviation greater than 112); * Calculated panel reactivity greater than 50% in class I and / or class II; * Presence in the pre-transplantation serum of donor class I and / or II anti-Human Leukocyte Antigen antibodies with intensity and fluorescence greater than 1000; * Occurrence of cellular or antibody-mediated rejection within 30 days prior to the date of the protocol biopsy. Exclusion Criteria: * Patients with contraindication to renal graft biopsy; * Patients whose biopsy fragments are not representative; * Patients with graft dysfunction in whom renal graft biopsy is indicated within 4 weeks prior to protocol biopsy.

Locations (1)

Hospital de Clinicas of Porto Alegre

Porto Alegre, Rio Grande do Sul, Brazil

Outcomes

Primary Outcomes

Incidence of rejection.

To evaluate the incidence of subclinical, cellular and antibody-mediated rejections in protocol biopsies performed on patients at high immune risk who underwent kidney transplantation.

Time frame: Three months post transplant.

Secondary Outcomes

Graft survival

Comparison of glomerular filtration rate at 2 years after transplantation between groups of patients with and without protocol biopsy using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Time frame: Two years post transplant.

Data from ClinicalTrials.gov

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