Longitudinal Study of Cell Free DNA in Lung Transplant

NCT04234919 | Completed

• 1 other identifier: 19-2946
• Study Type: observational
• Target: 24
• Locations: 1 country
• Sites: 1

Brief Summary

Lung transplant is a viable treatment strategy for many with end-stage lung diseases. Despite advances in both the surgical and medical management, lung transplant recipients experience episodes of allograft insult and injury that lead to dysfunction and ultimately contribute to graft failure. The primary noninvasive tool for monitoring the lung allograft, pulmonary function testing, is neither sensitive nor specific for lung allograft injury which makes the management of lung transplant recipients particularly challenging. A decline in pulmonary function tests prompts invasive procedures such as bronchoscopy with transbronchial lung biopsy to diagnose the cause of allograft injury, although this, too, is not 100% sensitive, and oftentimes patients are treated empirically for rejection when no other etiology for lung function decline is identified. Empiric treatment prompted by extrapulmonary drivers of decline in lung function may result in inappropriate exposure to risks of augmented immunosuppression. The purpose of this study is to determine to what extent monitoring of donor-derived cell free DNA in lung transplant recipients can be used as a marker of lung injury and stability.

Conditions

Lung Transplant Rejection

Outcome Measures

Primary Outcomes (1)

• Relationship

  Determine the relationship between donor derived cell free DNA and lung allograft function during the first year after lung transplant.

  12 Months

Secondary Outcomes (1)

• Quantitative Assessments

  12 Months

Study Arms (1)

Consented adult lung transplant recipients

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients with end stage lung disease who are placed on the lung transplant waitlist for consideration of a bilateral transplant at the University of Colorado lung transplant program will be recruited for participation in the study.

You may qualify if:

• ≥ 18 years old
• Actively listed or have recently had a double lung transplant
• Participant is willing and able to provide informed consent

You may not qualify if:

• Prior organ transplantation
• Transplantation performed in the setting of hospitalization for acute illness or decompensation
• Unable or unwilling to consent for enrolment
• Single lung transplant recipient
• Consideration for multi-organ transplantation
• Pregnant women

Sponsors & Collaborators

• University of Colorado, Denver: lead
• CareDx: collaborator

Study Sites (1)

University of Colorado, Denver

Aurora, Colorado, 80045, United States

Location

Related Publications (17)

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  PMID: 30293613 BACKGROUND

• Glanville AR, Aboyoun CL, Havryk A, Plit M, Rainer S, Malouf MA. Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation. Am J Respir Crit Care Med. 2008 May 1;177(9):1033-40. doi: 10.1164/rccm.200706-951OC. Epub 2008 Feb 8.

  PMID: 18263803 BACKGROUND

• Hopkins PM, Aboyoun CL, Chhajed PN, Malouf MA, Plit ML, Rainer SP, Glanville AR. Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis. Am J Respir Crit Care Med. 2004 Nov 1;170(9):1022-6. doi: 10.1164/rccm.200302-165OC. Epub 2004 Aug 5.

  PMID: 15297270 BACKGROUND

• Khalifah AP, Hachem RR, Chakinala MM, Yusen RD, Aloush A, Patterson GA, Mohanakumar T, Trulock EP, Walter MJ. Minimal acute rejection after lung transplantation: a risk for bronchiolitis obliterans syndrome. Am J Transplant. 2005 Aug;5(8):2022-30. doi: 10.1111/j.1600-6143.2005.00953.x.

  PMID: 15996255 BACKGROUND

• Morrell MR, Pilewski JM, Gries CJ, Pipeling MR, Crespo MM, Ensor CR, Yousem SA, D'Cunha J, Shigemura N, Bermudez CA, McDyer JF, Zeevi A. De novo donor-specific HLA antibodies are associated with early and high-grade bronchiolitis obliterans syndrome and death after lung transplantation. J Heart Lung Transplant. 2014 Dec;33(12):1288-94. doi: 10.1016/j.healun.2014.07.018. Epub 2014 Aug 23.

  PMID: 25443870 BACKGROUND

• Kulkarni HS, Bemiss BC, Hachem RR. Antibody-mediated Rejection in Lung Transplantation. Curr Transplant Rep. 2015 Dec;2(4):316-323. doi: 10.1007/s40472-015-0074-5. Epub 2015 Sep 30.

  PMID: 27896040 BACKGROUND

• Verleden GM, Glanville AR, Lease ED, Fisher AJ, Calabrese F, Corris PA, Ensor CR, Gottlieb J, Hachem RR, Lama V, Martinu T, Neil DAH, Singer LG, Snell G, Vos R. Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant. 2019 May;38(5):493-503. doi: 10.1016/j.healun.2019.03.009. Epub 2019 Apr 3. No abstract available.

  PMID: 30962148 BACKGROUND

• Glanville AR, Verleden GM, Todd JL, Benden C, Calabrese F, Gottlieb J, Hachem RR, Levine D, Meloni F, Palmer SM, Roman A, Sato M, Singer LG, Tokman S, Verleden SE, von der Thusen J, Vos R, Snell G. Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant. 2019 May;38(5):483-492. doi: 10.1016/j.healun.2019.03.008. Epub 2019 Apr 3. No abstract available.

  PMID: 31027539 BACKGROUND

• Glanville AR. Bronchoscopic monitoring after lung transplantation. Semin Respir Crit Care Med. 2010 Apr;31(2):208-21. doi: 10.1055/s-0030-1249117. Epub 2010 Mar 30.

  PMID: 20354933 BACKGROUND

• Rademacher J, Suhling H, Greer M, Haverich A, Welte T, Warnecke G, Gottlieb J. Safety and efficacy of outpatient bronchoscopy in lung transplant recipients - a single centre analysis of 3,197 procedures. Transplant Res. 2014 May 27;3:11. doi: 10.1186/2047-1440-3-11. eCollection 2014.

  PMID: 24917927 BACKGROUND

• Levine DJ, Glanville AR, Aboyoun C, Belperio J, Benden C, Berry GJ, Hachem R, Hayes D Jr, Neil D, Reinsmoen NL, Snyder LD, Sweet S, Tyan D, Verleden G, Westall G, Yusen RD, Zamora M, Zeevi A. Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2016 Apr;35(4):397-406. doi: 10.1016/j.healun.2016.01.1223. Epub 2016 Feb 10.

  PMID: 27044531 BACKGROUND

• Safavi S, Robinson DR, Soresi S, Carby M, Smith JD. De novo donor HLA-specific antibodies predict development of bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant. 2014 Dec;33(12):1273-81. doi: 10.1016/j.healun.2014.07.012. Epub 2014 Jul 21.

  PMID: 25130554 BACKGROUND

• Snyder LD, Wang Z, Chen DF, Reinsmoen NL, Finlen-Copeland CA, Davis WA, Zaas DW, Palmer SM. Implications for human leukocyte antigen antibodies after lung transplantation: a 10-year experience in 441 patients. Chest. 2013 Jul;144(1):226-233. doi: 10.1378/chest.12-0587.

  PMID: 23328795 BACKGROUND

• Bharat A, Saini D, Steward N, Hachem R, Trulock EP, Patterson GA, Meyers BF, Mohanakumar T. Antibodies to self-antigens predispose to primary lung allograft dysfunction and chronic rejection. Ann Thorac Surg. 2010 Oct;90(4):1094-101. doi: 10.1016/j.athoracsur.2010.06.009.

  PMID: 20868794 BACKGROUND

• Akbarpour M, Wu Q, Liu X, Sun H, Lecuona E, Tomic R, Bhorade S, Mohanakumar T, Bharat A. Clinical relevance of lung-restricted antibodies in lung transplantation. Hum Immunol. 2019 Aug;80(8):595-601. doi: 10.1016/j.humimm.2019.04.016. Epub 2019 May 8.

  PMID: 31078336 BACKGROUND

• Emtiazjoo AM, Wilkes DS. Humoral immunity and the development of obliterative bronchiolitis after lung transplantation: is there a link? Am J Respir Cell Mol Biol. 2013 Feb;48(2):145-9. doi: 10.1165/rcmb.2012-0349RT. Epub 2012 Oct 18.

  PMID: 23087052 BACKGROUND

• Weigt SS, Wang X, Palchevskiy V, Gregson AL, Patel N, DerHovanessian A, Shino MY, Sayah DM, Birjandi S, Lynch JP 3rd, Saggar R, Ardehali A, Ross DJ, Palmer SM, Elashoff D, Belperio JA. Gene Expression Profiling of Bronchoalveolar Lavage Cells Preceding a Clinical Diagnosis of Chronic Lung Allograft Dysfunction. PLoS One. 2017 Jan 19;12(1):e0169894. doi: 10.1371/journal.pone.0169894. eCollection 2017.

  PMID: 28103284 BACKGROUND

Study Officials

• Alice L Gray, MD

  University of Colorado, Denver

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 15, 2020
• First Posted: January 21, 2020
• Study Start: March 19, 2020
• Primary Completion: November 22, 2021
• Study Completion: November 22, 2021
• Last Updated: November 2, 2022

Record last verified: 2022-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)