Kidney TransplantationNCT00056784
The Role of Connective Tissue Growth Factor in the Development of Kidney Disease After Organ Transplantation
An observational study of Kidney Transplantation, run by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at 1 site in United States.
Trial summary
This study will examine whether measurements of connective tissue growth factor (CTGF) and other cell proteins can identify which kidney transplant recipients are likely to develop chronic allograft nephropathy (CAN), a disease of the transplanted kidney. CAN may occur months to years after the transplant. Read more about this study
- Who is it for?
- Ages 4 years and older
- Conditions the study is for
- Kidney Transplantation
- How many people
- 134 participants
- Where
- 1 siteUnited States
- Study dates
- 20 Mar 2003to 17 Jun 2014
- Phase
- Observational
- 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 4 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Recipients of living related, living unrelated, and cadaveric kidney transplants.
- This study will be open to all patients currently enrolled in NIDDK transplant protocols as well as patients recruited from other transplant centers.
- Ability and willingness to provide informed consent (adults greater than or equal to 18.0 years) or assent (children 4 to 18.0 years).
Who cannot join
- Inability to provide informed consent.
- Inability to return to NIH for follow-up.
- Inability or unwillingness to release outside medical records or pathology.
Trial locations and contacts
1 site in 1 country.
United States1 site
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, 20892
About this study
Official title: The Pathogenesis of Chronic Graft Failure After Kidney Transplantation
This study will examine whether measurements of connective tissue growth factor (CTGF) and other cell proteins can identify which kidney transplant recipients are likely to develop chronic allograft nephropathy (CAN), a disease of the transplanted kidney. CAN may occur months to years after the transplant. The kidney becomes progressively scarred and eventually loses all function, so that dialysis or another transplant is needed. A better understanding of how CTGF and other proteins are involved in the development of CAN may provide new targets for treating for the disease.
Patients who are scheduled to receive a kidney or combined kidney-pancreas transplant or who have received a transplant recently (within 6 months) may be eligible for this study. Participants will be enrolled before the transplant, if possible, or after the transplant, and will undergo the following tests and procedures:
- Physical examinations at the screening visit, at 1, 6, 12, and 24 months, and then once yearly.
- Blood sample collections at the screening visit, at 1, 6, 12, 18, and 24 months and then once yearly.
- Urine sample collections at the screening visit, at 1, 6, 12, 18, and 24 months and then once yearly.
- Kidney biopsies at the beginning of the study, at 1, 6, 12, and 24 months, and then once a year for research purposes. Participants may refuse to have a research biopsy at any time during the study. Also, patients who are having a kidney biopsy for another reason at these time points will not have a second biopsy. The biopsy procedure takes about 15 minutes and is done in the hospital. The patient lies on his or her back and the skin over the transplanted kidney is cleaned with alcohol and iodine. The area is numbed with an injection of an anesthetic, and then a biopsy needle is placed through the kin. The biopsy may be repeated up to three times to get enough tissue to test for CAN. Patients lie flat for 4 hours after the procedure to reduce the risk of bleeding, and are observed for another 2 hours for possible complications.
Read the detailed description
Following transplantation, recipients of organ allografts are placed on immunosuppression indefinitely. Despite dramatic improvements in acute rejection rates and short-term graft survival, long term graft survival has not changed appreciably over the past 20 years. In kidney transplantation, the leading cause of late graft loss is chronic allograft nephropathy (CAN). This disorder is clinically characterized by a progressive decline in kidney function, associated with the characteristic histologic features of interstitial fibrosis and inflammation, arteriosclerosis, glomerulosclerosis, and tubular atrophy. Both immunologic and non-immunologic factors have been implicated in the development of CAN. However, the etiology of this disorder has not been clearly defined nor is there specific therapy for treating CAN.
Implicated in the development of CAN in rodents and humans is transforming growth factor beta (TGF-beta), a pleiotropic cytokine which is elevated in CAN recipients, and stimulates matrix deposition within the graft. A downstream effector of TGF-b is connective tissue growth factor (CTGF), which has been recently associated with other fibrotic renal diseases. In preliminary studies in a mouse model of CAN, CTGF gene expression is increased in kidney transplants with CAN. However, its role in human CAN is unknown.
The aim of this investigation is to identify whether CTGF may play a role in the pathogenesis of CAN in humans. Our long-term objective is to determine whether CTGF and other cytokine mediators may be novel targets for the therapy of CAN. Our goals are to: 1. Determine the level of CTGF expressed in the urine and serum CTGF of recipients of kidney transplants; 2. Identify whether urinary or serum CTGF might be a marker of CAN and be utilized as a predictor for those at risk to develop the disease; 3. Identify other molecular messages and proteins that may identify the development of CAN, as potential future targets of treatment.
In this prospective study, serial urine and serum samples will be obtained in recipients, before, during, and after transplantation of a kidney allograft. The graft will be monitored in the context of standard measures of renal function, which include serum creatinine and creatinine clearance. These results will be correlated with other clinically descriptive information regarding the recipient s transplant.
- Conditions
- Kidney Transplantation
- Keywords
- TGF-Beta, Kidney, Transplantation, Rejection, Immunosuppression, Kidney Transplant, Chronic Allograft Nephropathy, CAN
- Medical subject headings
- Camurati-Engelmann Syndrome, Rejection, Psychology
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Mar 2003 (estimated)
- Study start20 Mar 2003
- Study completion17 Jun 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Kidney TransplantationStudies of the same condition, open and under way.
- More trials run by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)The sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Enrolment
- 134 participants (actual)
Sponsor and investigators
- Sponsor type
- US National Institutes of Health
- Investigators
- Monique E Cho, M.D., Principal investigator, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00056784
- Sponsor's protocol ID
- 030132
- Other IDs
- 03-DK-0132
- Status last verified
- 17 Jun 2014
- First submitted
- 22 Mar 2003
- Last updated
- 6 Oct 2017
- Results posted
- No
Publications
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec 2;341(23):1725-30. doi: 10.1056/NEJM199912023412303.
PubMed 10580071Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000 Mar 2;342(9):605-12. doi: 10.1056/NEJM200003023420901.
PubMed 10699159Cecka JM. The UNOS renal transplant registry. Clin Transpl. 2001:1-18.
PubMed 12211771
Study at a glance
From the registry record, last updated by the sponsor on 6 Oct 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Pathogenesis of Chronic Graft Failure After Kidney Transplantation
- ClinicalTrials.gov ID
- NCT00056784
- Acronym / sponsor ID
- 030132
- Conditions
- Kidney Transplantation
- Keywords
- TGF-Beta, Kidney, Transplantation, Rejection, Immunosuppression, Kidney Transplant, Chronic Allograft Nephropathy, CAN
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 134 participants (actual)
- Lead sponsor
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)US National Institutes of Health
- Study start
- 20 Mar 2003
- Study completion
- 17 Jun 2014
- First posted
- 24 Mar 2003 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will examine whether measurements of connective tissue growth factor (CTGF) and other cell proteins can identify which kidney transplant recipients are likely to develop chronic allograft nephropathy (CAN), a disease of the transplanted kidney. CAN may occur months to years after the transplant. The kidney becomes progressively scarred and eventually loses all function, so that dialysis or another transplant is needed. A better understanding of how CTGF and other proteins are involved in the development of CAN may provide new targets for treating for the disease.
Patients who are scheduled to receive a kidney or combined kidney-pancreas transplant or who have received a transplant recently (within 6 months) may be eligible for this study. Participants will be enrolled before the transplant, if possible, or after the transplant, and will undergo the following tests and procedures:
- Physical examinations at the screening visit, at 1, 6, 12, and 24 months, and then once yearly.
- Blood sample collections at the screening visit, at 1, 6, 12, 18, and 24 months and then once yearly.
- Urine sample collections at the screening visit, at 1, 6, 12, 18, and 24 months and then once yearly.
- Kidney biopsies at the beginning of the study, at 1, 6, 12, and 24 months, and then once a year for research purposes. Participants may refuse to have a research biopsy at any time during the study. Also, patients who are having a kidney biopsy for another reason at these time points will not have a second biopsy. The biopsy procedure takes about 15 minutes and is done in the hospital. The patient lies on his or her back and the skin over the transplanted kidney is cleaned with alcohol and iodine. The area is numbed with an injection of an anesthetic, and then a biopsy needle is placed through the kin. The biopsy may be repeated up to three times to get enough tissue to test for CAN. Patients lie flat for 4 hours after the procedure to reduce the risk of bleeding, and are observed for another 2 hours for possible complications.
Detailed description
Following transplantation, recipients of organ allografts are placed on immunosuppression indefinitely. Despite dramatic improvements in acute rejection rates and short-term graft survival, long term graft survival has not changed appreciably over the past 20 years. In kidney transplantation, the leading cause of late graft loss is chronic allograft nephropathy (CAN). This disorder is clinically characterized by a progressive decline in kidney function, associated with the characteristic histologic features of interstitial fibrosis and inflammation, arteriosclerosis, glomerulosclerosis, and tubular atrophy. Both immunologic and non-immunologic factors have been implicated in the development of CAN. However, the etiology of this disorder has not been clearly defined nor is there specific therapy for treating CAN.
Implicated in the development of CAN in rodents and humans is transforming growth factor beta (TGF-beta), a pleiotropic cytokine which is elevated in CAN recipients, and stimulates matrix deposition within the graft. A downstream effector of TGF-b is connective tissue growth factor (CTGF), which has been recently associated with other fibrotic renal diseases. In preliminary studies in a mouse model of CAN, CTGF gene expression is increased in kidney transplants with CAN. However, its role in human CAN is unknown.
The aim of this investigation is to identify whether CTGF may play a role in the pathogenesis of CAN in humans. Our long-term objective is to determine whether CTGF and other cytokine mediators may be novel targets for the therapy of CAN. Our goals are to: 1. Determine the level of CTGF expressed in the urine and serum CTGF of recipients of kidney transplants; 2. Identify whether urinary or serum CTGF might be a marker of CAN and be utilized as a predictor for those at risk to develop the disease; 3. Identify other molecular messages and proteins that may identify the development of CAN, as potential future targets of treatment.
In this prospective study, serial urine and serum samples will be obtained in recipients, before, during, and after transplantation of a kidney allograft. The graft will be monitored in the context of standard measures of renal function, which include serum creatinine and creatinine clearance. These results will be correlated with other clinically descriptive information regarding the recipient s transplant.
Study design
Who may qualify
- Ages
- 4 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (3 listed)
- Recipients of living related, living unrelated, and cadaveric kidney transplants.
- This study will be open to all patients currently enrolled in NIDDK transplant protocols as well as patients recruited from other transplant centers.
- Ability and willingness to provide informed consent (adults greater than or equal to 18.0 years) or assent (children 4 to 18.0 years).
Key exclusion criteria (3 listed)
- Inability to provide informed consent.
- Inability to return to NIH for follow-up.
- Inability or unwillingness to release outside medical records or pathology.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Not reported in the source record.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Oct 2017.
- Background: PubMed 10580071Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec 2;341(23):1725-30. doi: 10.1056/NEJM199912023412303.
- Background: PubMed 10699159Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000 Mar 2;342(9):605-12. doi: 10.1056/NEJM200003023420901.
- Background: PubMed 12211771Cecka JM. The UNOS renal transplant registry. Clin Transpl. 2001:1-18.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Monique E Cho, M.D. principal investigator
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Kidney Transplantation, run by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at 1 site in United States.
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 3 inclusion and 3 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 6 Oct 2017. 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 United States. 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.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00056784, which also lists 3 linked publications.
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 6 Oct 2017.