AzTrials
AzTrials

Kidney TransplantationDADINCT03477656

Evaluation of 2 Techniques of Apheresis to Desensitize ABO Incompatible Kidney Transplant Candidates

A study testing Large volume specific immunoadsorption and Double Filtration Plasmapheresis in people with Kidney Transplantation, run by University Hospital, Toulouse at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Kidney transplantation is the treatment of choice for end-stage renal disease. ABO incompatible (ABOi) living donor kidney transplantation is one of the best ways to expand the donors' pool. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Kidney Transplantation
What is being tested?
Large volume specific immunoadsorption and Double Filtration Plasmapheresis
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
1 siteFrance
Study dates
2 May 2018to 3 Oct 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient eligible for living donor ABO incompatible kidney transplantation
  • Presenting an IsoAgglutinin immunoglobulin G titer (anti-A-B) between 1/8 and 1/128, before desensitization
  • Patient older than 18 years
  • Women of childbearing age must have a pregnancy test before starting the study and undergoing study. They must take an effective and acceptable method of contraception before starting the study and throughout the study period. Sexually active men should use a condom throughout the course of the study
  • Patient able to sign an informed consent form
  • Patient affiliated with a social security scheme

Who cannot join

  • Presence of anti-HLA (Human Leucocyte Antigens) allo-antibodies
  • Patient with comorbidities that prevent desensitization protocols
  • Women who are pregnant, or who may become pregnant or breastfeeding women
  • History of hypersensitivity related to a component of the apheresis membrane
  • Subjects under legal protection
  • Subjects participating in another interventional research protocol or in an exclusion period from another interventional research protocol

Trial locations and contacts

1 site in 1 country.

France1 site
  • University Hospital Toulouse (Hospital Rangueil)

    Toulouse, 31059

Other trials in France

About this study

Official title: Evaluation of 2 Techniques of Apheresis to Desensitize ABO Incompatible Kidney Transplant Candidates: Double Filtration PlasmaPheresis (DFPP) vs Large Plasma Volume Specific ImmunoAdsorption

Kidney transplantation is the treatment of choice for end-stage renal disease. ABO incompatible (ABOi) living donor kidney transplantation is one of the best ways to expand the donors' pool. However, breaking the ABO barrier is possible only with a preconditioning regimen that includes 1) an immunosuppressive strategy using a B-cell depleting agent (rituximab), an induction therapy with polyclonal antibodies, and a maintenance triple immunosuppressive therapy based on calcineurin inhibitors, and 2) a desensitization protocol aiming to decrease the titer of isoagglutinins. For this purpose, several techniques of apheresis are available. To date, two main techniques used in clinical setting are the Double-Filtration PlasmaPheresis (DFPP) and the Antigen-Specific Immunoadsorption (SIA). DFPP permits the depletion of the selective plasma fraction containing Immunoglobulins, while limiting the need for plasma substitution. SIA enables to remove ABO antibodies without a major loss in essential plasma components. To date, no randomized study comparing DFPP and SIA exist. SIA is less often used because of its high cost. However, in order to reduce the number of SIA sessions and consequently its cost, large plasma volume sessions of SIA are performed. ABOi is dramatically more expensive than ABO compatible kidney transplantation. A large part of the difference in the cost is related to the apheresis technique.

Herein, the investigator proposes to describe the efficacy, the safety, and the cost of DFPP and SIA to desensitize ABO incompatible kidney transplant candidates.

Read the detailed description

All recipients will receive an induction therapy with rituximab and polyclonal antibodies, as well as a maintenance therapy by tacrolimus, mycophenolic acid (switched for mTOR (Mechanistic target of rapamycin) inhibitors 1 month after the transplantation to avoid viral infections) and steroids.

The desensitization protocol will be based on the initial titer of isoagglutinin. All patients with an isoagglutinin titer between 1/8 and 1/128 will be included in this monocentric, open label study, and randomized between the DFPP arm (1 to 4 sessions according to the initial titer) and large-plasma SIA (1 to 2 sessions according to the titer). The effectiveness will be evaluated on the ability to obtain the targeted titer before transplantation (1/4) with less than 5 DFPP, or 2 large-plasma volume SIA.

All recipients will be followed for 6 months, and examined for surgical complications, rejection rate, and kidney function. All complications related to desensitization protocol will be reported. Moreover, all cost associated with these two apheresis techniques will be evaluated.

Being tested
Large volume specific immunoadsorption, Double Filtration Plasmapheresis
Keywords
ABO incompatible kidney transplantation, Desensitization, Double Filtration PlasmaPherisis (DFPP), Specific immunoadsorption, Living donor kidney transplantation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Large volume specific immunoadsorptionProcedure or surgery

    1 to 2 sessions of large volume specific immunoadsorption using GLYCOSORB®-ABO column

  • Double Filtration PlasmapheresisProcedure or surgery

    1 to 5 sessions of double filtration plasmapheresis

Study groups in NCT03477656
Study groupRoleWhat they receive
Large volume specific immunoadsorptionExperimental1 to 2 sessions of large volume specific immunoadsorption according to the initial isoagglutinin titer.
Receives: Procedure: Large volume specific immunoadsorption
Double Filtration PlasmapheresisExperimental1 to 5 sessions of double filtration plasmapheresis according to the initial isoagglutinin titer.
Receives: Procedure: Double Filtration Plasmapheresis

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Success rate

    % of subjects with the targeted isoagglutinin titer (≤1/4) before transplantation with less than 5 DFPP sessions (for the DFPP arm) or 2 large plasma volume specific immunoadsorption sessions (for the specific immunoadsorption arm)

    Measured: the day of transplantation

Secondary outcomes (34)
  1. Differential cost-efficacy ratio of support for patients receiving a live donor kidney transplant Incompatible ABO and benefiting from a desensitization procedure

    Direct medical costs ( treatments costs, costs of hospital stays, costs of outpatient cares) will be evaluated from the society point of view.

    A cost-efficacy analysis, comparative of medical consequences, measured in terms of number of complications related to the technique and post surgical at 7 months, and the economic consequences will be realized.

    Measured: 7 months

  2. Surgical complication rate during the desensitization sessions

    % of subjects with surgical complications during the desensitization sessions

    Measured: From the first desensitization session to the last one, assessed up to 10 days

  3. Surgical complication rate during the transplantation surgery

    % of subjects with surgical complications during the transplantation surgery

    Measured: During the transplantation surgery

  4. Thrombotic complication rate during the desensitization sessions

    % of subjects with thrombotic complications during the desensitization sessions

    Measured: From the first desensitization session to the last one, assessed up to 10 days

  5. Thrombotic complication rate 1 week after transplantation surgery

    % of subjects with thrombotic complications until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  6. Rate of bleeding and/or hematoma on vascular access during the desensitization sessions

    % of subjects with bleeding and/or hematoma on vascular access during the desensitization sessions

    Measured: From the first desensitization session to the last one, assessed up to 10 days

  7. Rate of hematoma occurrence during the transplantation surgery

    % of subjects with hematoma during the transplantation surgery

    Measured: During the transplantation surgery

  8. Rate of occurrences of hemorrhage away from vascular access during the desensitization sessions

    % of subjects with hemorrhage away from vascular access during the desensitization sessions

    Measured: From the first desensitization session to the last one, assessed up to 10 days

  9. Rate of occurrences of allergy to the components of the membrane or of the blood circuit (tube set) during the desensitization sessions

    % of subjects with allergy to the components of the membrane or of the blood circuit (tube set) during the desensitization sessions

    Measured: From the first desensitization session to the last one, assessed up to 10 days

  10. Rate of occurrences of allergy to the components of the membrane or of the blood circuit (tube set) 1 week after transplantation surgery

    % of subjects with allergy to the components of the membrane or of the blood circuit (tube set) until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  11. Blood transfusion rate before transplantation

    % of subjects who received blood transfusion before transplantation

    Measured: Before transplantation

  12. Blood transfusion rate during the transplantation surgery

    % of subjects who received blood transfusion during the transplantation surgery

    Measured: During the transplantation surgery

  13. Blood transfusion rate 1 week after transplantation surgery

    % of subjects who received blood transfusion until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  14. Occurrence rate of deep vein or graft vein thrombosis during the transplantation surgery

    % of subjects with deep vein or graft vein thrombosis during the transplantation surgery

    Measured: During the transplantation surgery

  15. Graft ablation rate 1 week after transplantation surgery

    % of subjects with graft ablation until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  16. Complication rate on surgical area 1 week after transplantation surgery

    % of subjects with complication on the surgical area until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  17. Infectious complication rate 1 week after transplantation surgery

    % of subjects with Infectious complication until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  18. Need for dialysis session(s) 1 week after transplantation surgery

    number of subjects for which one or several dialysis session(s) is necessary until 1 week after transplantation surgery

    Measured: 1 week after transplantation surgery

  19. Graft rejection rate 1 month after transplantation surgery

    % of subjects with graft rejection until 1 month after transplantation surgery

    Measured: 1 month after transplantation surgery

  20. Graft rejection rate 3 months after transplantation surgery

    % of subjects with graft rejection until 3 months after transplantation surgery

    Measured: 3 months after transplantation surgery

  21. Graft rejection rate 6 months after transplantation surgery

    % of subjects with graft rejection until 6 months after transplantation surgery

    Measured: 6 months after transplantation surgery

  22. Renal function 1 month after transplantation surgery

    creatinine 1 month after transplantation surgery

    Measured: 1 month after transplantation surgery

  23. Renal function 3 months after transplantation surgery

    creatinine 3 months after transplantation surgery

    Measured: 3 months after transplantation surgery

  24. Renal function 6 months after transplantation surgery

    creatinine 6 months after transplantation surgery

    Measured: 6 months after transplantation surgery

  25. Change in hemostasis parameters from before the desensitization protocol to after

    plasma level of fibrinogen clotting factors

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  26. Change in hemostasis parameters from before the desensitization protocol to after

    plasma level of factor XIII

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  27. Change in hemostasis parameters from before the desensitization protocol to after

    plasma level of thrombin-antithrombin complex

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  28. Change in hemostasis parameters from before the desensitization protocol to after

    plasma level of platelet secretion proteins (sCD40L, PF4)

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  29. Change in hemostasis parameters from before the desensitization protocol to after

    plasma level of ADAMTS13 metalloprotease

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  30. Change in hemostasis parameters from before the desensitization protocol to after

    Von Willebrand factor (cleaved form)

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  31. Change in hemostasis parameters from before the desensitization protocol to after

    blood level of platelet-monocyte complexes

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  32. Change in hemostasis parameters from before the desensitization protocol to after

    blood level of platelet-neutrophil polynuclear complexes

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  33. Change in hemostasis parameters from before the desensitization protocol to after

    endogenous thrombin potential

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

  34. Change in hemostasis parameters from before the desensitization protocol to after

    peak thrombin

    Measured: the day of the first desensitization session (just before the session) and the day after the last desensitization session (up to 11 days)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Mar 2018
  2. Study start2 May 2018
  3. Primary completion3 Oct 2023
  4. Study completion3 Oct 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03477656
Sponsor's protocol ID
RC31/16/8767
Acronym
DADI
Status last verified
Apr 2024
First submitted
9 Feb 2018
Last updated
12 Apr 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Large volume specific immunoadsorption and Double Filtration Plasmapheresis in people with Kidney Transplantation, run by University Hospital, Toulouse at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Success rate (time frame: the day of transplantation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Apr 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in