Pilot Study on the Use of Sirolimus to Treat Chronic Allograft Nephropathy in Children After Kidney Transplant

NCT00188955 | Completed Phase 4

• 1 other identifier: WINNIPEG-CAN-1
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to determine whether treatment with sirolimus, in combination with low-dose tacrolimus and prednisone, is effective for the treatment of chronic allograft nephropathy (progressive scarring) in children who have previously received a kidney transplant. This treatment is compared to the standard therapy which uses low-dose tacrolimus, mycophenolate mofetil and prednisons. This study is a pilot study that will determine whether treatment with sirolimus reduces or improves the rate of scarring seen on kidney biopsy of the transplanted kidney over time, compared to children who continue to be treated with mycophenolate mofetil.

Conditions

Kidney Transplantation

Keywords

pediatric; chronic allograft nephropathy; chronic rejection; interstitial fibrosis

Outcome Measures

Primary Outcomes (1)

• histological quantification of interstitial fibrosis at 2 years

Secondary Outcomes (4)

• Renal function at 1 and 2 years.

• Proteinuria at 2 years.

• Freedom from acute rejection and graft loss over the 2 year study period.

• Cumulative incidence and prevalence of adverse events and serious adverse events over the 2-year study period.

Interventions

sirolimus DRUG

Eligibility Criteria

• Age: 6 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• All male or female patients aged less than 17 years.
• The patient has undergone a kidney transplant, from a cadaveric or living donor with compatible ABO blood type.
• The patient is more than 12 months post-transplantation.
• The allograft demonstrates histological changes consistent with CAN according to the Banff 97 classification schema (minimum of ct1 and ci1 score for tubular atrophy and interstitial fibrosis respectively).

You may not qualify if:

• The patient, or in case the patient is minor, the patient's parent(s) or their legal representative, has been fully informed and will not give informed consent to participate in the study.
• The allograft demonstrates histological changes at the time of enrollment consistent with acute allograft rejection Grade Ia or worse, according to the Banff 97 classification schema (minimum of t2 and i2 score for tubulitis and interstitial inflammation respectively).
• The patient is known to be allergic or intolerant to MMF, sirolimus or any of their known metabolites.
• The patient for who routine protocol kidney biopsy is contraindicated.
• Patients whose maintenance immunosuppression does not include both tacrolimus and prednisone at the time on study enrollment.
• Patients previously treated with sirolimus.
• The patient requires ongoing dosing with a systemic immunosuppressive drug at study entry for any reason other than kidney transplantation.
• The patient and/or donor is known to be HIV or HCV positive.
• The patient has significant liver disease, defined as having during the past 28 days continuously elevated ASAT (SGOT) and/or ALAT (SGPT) levels greater than 3 times the upper value of the normal range of the investigational site.
• The patient has persistent leukopenia (WBC \<3.0 x109/L).
• The patient has persistent thrombocytopenia (\<100 x109/L).
• The patient has pre-existing significant hyperlipidemia (total cholesterol \>7.8 mmol/L), not responding to medical therapy.
• The patient has pre-existing elevated triglycerides, not responding to medical therapy.
• The patient with malignancy or history of malignancy except for successfully treated Wilm's tumor (2 years) or non-metastatic basal or squamous cell carcinoma of the skin that has been treated successfully.
• The patient has significant, uncontrolled concomitant infections and/or severe diarrhea, vomiting or active peptic ulcer.

Sponsors & Collaborators

• University of Manitoba: lead
• Wyeth is now a wholly owned subsidiary of Pfizer: collaborator

Study Sites (1)

Children's Hospital

Winnipeg, Manitoba, R3A 1S1, Canada

Location

Related Links

• Manitoba Institute of Child Health
• Children's Hospital in Winnipeg
• University of Manitoba

MeSH Terms

Conditions

Pulmonary Fibrosis

Interventions

Sirolimus

Condition Hierarchy (Ancestors)

Lung Diseases, Interstitial; Lung Diseases; Respiratory Tract Diseases; Fibrosis; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Macrolides; Lactones; Organic Chemicals

Study Officials

• Tom D. Blydt-Hansen, MD

  University of Manitoba, Manitoba Institute of Child Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: September 10, 2005
• First Posted: September 16, 2005
• Study Start: March 1, 2004
• Study Completion: October 1, 2008
• Last Updated: February 22, 2010

Record last verified: 2010-02

Locations

CA (1)