Background: Subclinical inflammation, including borderline lesions (BL), is very common (30-40%) after kidney transplantation (KT), even in low immunological risk patients, and can lead to interstitial fibrosis/tubular atrophy (IFTA) and worsening of renal function with graft loss. Few controlled studies have analyzed the therapeutic benefit of these BL on renal function and graft histology. Furthermore, these studies have only used bolus steroids, which may be insufficient to slow the progression of these lesions. Klotho, a transmembrane protein produced mainly in the kidney with antifibrotic properties, plays a crucial role in the senescence-inflammation binomial of kidney tissue. Systemic and local inflammation decrease renal tissue expression and soluble levels of α-klotho. It is therefore important to determine whether treatment of BL prevents a decrease in α klotho levels, progression of IFTA, and loss of kidney function. Methods: The TRAINING study will randomize 80 patients with low immunological risk who will receive their first KT. The aim of the study is to determine whether the treatment of early BL (3rd month post-KT) with polyclonal rabbit antithymocyte globulin (Grafalon®) (6 mg/kg/day) prevents or decreases the progression of IFTA and the worsening of graft function compared to conventional therapy after two years post-TX, as well as to analyze whether treatment of BL with Grafalon® can modify the expression and levels of klotho, as well as the pro-inflammatory cytokines that regulate its expression.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
When Borderline lesions are present in protocol biopsy, administer Grafalon ® 6 mg/kg/day in a single day. Then continue with the normal treatment: Steroids (5 mg/day), tacrolimus (0.1 mg/kg/day) and mycophenolate (1000 mg/day).
When Borderline lesions are present in protocol biopsy, administer the normal treatment: Steroids (5 mg/day), tacrolimus (0.1 mg/kg/day) and mycophenolate (1000 mg/day)
Hospital Universitario de Canarias
Santa Cruz de Tenerife, None Selected, Spain
RECRUITINGFundación Puigvert
Barcelona, Spain
RECRUITINGHospital Universitari Valld´Hebron
Barcelona, Spain
RECRUITINGVeronica Lopez Jimenez
Málaga, Spain
RECRUITINGPresence of interstitial fibrosis/tubular atrophy (IFTA)
Measurement at 24 months according to the Banff classification. The Banff Classification of Allograft Pathology is an international consensus classification for the reporting of biopsies from solid organ transplant.
Time frame: 24 months
Renal function measured with CKD-EPI
Renal function after kidney transplant in both groups at 24 months measured according to glomerular filtration rate determined by CKD-EPI formula
Time frame: 24 months
Graft Survival
Graft survival after kidney transplant in both groups
Time frame: 24 months
Patient Survival
Patient survival after kidney transplant in both groups
Time frame: 24 months
Assess the Adherence to Immunosuppressive Therapy in the Two Treatment Groups
The Basle scale was used to assess adherence to immunosuppressive therapy.
Time frame: 24 months
Incidence of Diabetes Mellitus
Incidence of diabetes mellitus after kidney transplant in both groups at 1, 2, 3, 4, 6, 9, 12, 18 and 24 months
Time frame: 24 months
Blood Pressure mmHg
Blood pressure after kidney transplant in both groups at 24 months
Time frame: 24 months
Number of Participants With Acute Rejection Lesions
Patients with acute rejection lesions (including subclinical rejection) at 24 months according to Banff classification
Time frame: 24 months
Lipid Profile cholesterol, triglycerides
Lipid profile after kidney transplant in both groups at 24 months
Time frame: 24 months
Klotho levels pg/ml
Klotho levels after kidney transplant in both groups at 1, 3, 6, 12 and 24 months
Time frame: 24 months
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