AzTrials
AzTrials

RefluxRESULTNCT01406210

RESULT (REflux Surgery in Lung Transplantation) Preliminary Study Protocol

An observational study of Reflux and Gastroesophageal Reflux Disease (GERD), run by Duke University at 4 sites in 2 countries.

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

The purpose of the prospective study is to collect information surrounding lung transplant in order to develop a randomized study to determine if prevention of gastroesophageal reflux disease (GERD) related aspiration (stomach acid coming up from the stomach into the esophagus) by surgical fundoplication improves lung… Read more about this study

Who is it for?
Ages 16 years and older
How many people
647 participants
Where
4 sitesin 2 countries
Study dates
Sep 2011to Aug 2013
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 16 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: Male or non-pregnant female subject ≥16 years of age with a double-lung transplant who have undergone a 24-hour esophageal pH and/orimpedance probe study within 12 months prior to transplant and/or within 12 months following transplantation.

Who may be able to join

  • Male or non-pregnant female subject
  • 16 years of age
  • Recipient of a double-lung transplant
  • Previously have a 24-hour esophageal pH and/or impedance probe study within 12 months prior to transplant and/or within 12 months following transplantation. If the subject expired prior to 12 months from transplant date, they must have had a 24-hour esophageal pH and/or impedance probe study to be eligible in the study.

Who cannot join

  • Recipient of a single-lung transplant
  • Recipient of a re-do lung transplant
  • Recipient of a double-lung/heart or double-lung/ other organ transplant
  • Do not have a 24-hour esophageal pH and/or impedance probe study within 12 months pre-transplant or within 12 months following transplantation. The subject expired less than 12 months post transplant without having a 24-hour esophageal pH and/or impedance probe study
  • No Spirometry data is available for the subject
  • Subject who is participating in any other interventional clinical study
  • Unable to provide written informed consent or participate in long-term follow-up

Trial locations and contacts

4 sites in 2 countries.

4 sites in 2 countries

United States3 sites
  • Johns Hopkins University School of Medicine

    Baltimore, Maryland, 21287

  • Cleveland Clinic

    Cleveland, Ohio, 44195

  • Duke University Medical Center

    Durham, North Carolina, 27710

Other trials in United States

Canada1 site
  • University of Toronto

    Toronto, Ontario, M5G2C4

Other trials in Canada

About this study

Official title: Prospective and Retrospective Study to Develop a Multi-center Randomized Study, to Determine if Prevention of GERD Related Aspiration by Surgical Fundoplication Improves Lung Allograft Function

The purpose of the prospective study is to collect information surrounding lung transplant in order to develop a randomized study to determine if prevention of gastroesophageal reflux disease (GERD) related aspiration (stomach acid coming up from the stomach into the esophagus) by surgical fundoplication improves lung rejection. Lung transplantation has evolved into an effective treatment for patients with end-stage lung disease; however, a significant limitation to long-term survival is patients develop a condition of scarring known as chronic lung rejection, which can cause lung function to deteriorate, thereby reducing a patient's chances for survival. Preliminary research has shown a correlation between the presence of gastroesophageal reflux disease (GERD) and impaired early lung rejection as assessed by a breathing test, FEV1 (the amount of forced expired air volume in 1 second).

The Investigator is interested in learning more about this condition and the potential for aspiration (inhaling fluid) injury. The primary goal of this preliminary study will be to identify aspiration markers that are correlated with adverse clinical outcomes (increased early rejection, decreased FEV1) that may be used as inclusion criteria for the future randomized trial.

Read more

The purpose of the retrospective study is to collect information surrounding lung transplant in order to develop a randomized study to determine if prevention of gastroesophageal reflux disease (GERD) related aspiration (stomach acid coming up from the stomach into the esophagus) by surgical fundoplication improves lung rejection.

The goal of this retrospective data collection is to review the following:

  1. subject outcome event rates for subjects with and without gastroesophageal reflux disease (GERD) for survival, Bronchiolitis Obliterans Syndrome (BOS), acute rejection and Forced Expiratory Volume in the first second (FEV-1),
  2. the estimated treatment effect of fundoplication on the above event rates,
  3. a threshold effect for Bronchiolitis Obliterans Syndrome (BOS) and/or death are more likely to occur at higher or more proximal acid or non-acid contact times.

This data will be collected in order to better design and coordinate a multicenter prospective study.

Read the detailed description

Prospective Group: Approximately 125 Bronchoalveolar Lavage (BAL) samples will be collected from eligible subjects at the time of clinical bronchoscopies and will be within 2 weeks of their esophageal study. The Bronchoalveolar Lavage (BAL) samples will be assayed for bile acids; pepsin, pepsinogen I and II; trypsin; gastrin, and Lipopolysaccharide (LPS) content. Short-term clinical outcome measures including acute rejection episodes, and Forced Expiratory Volume in the first second (FEV-1) at one year will be collected. Correlation between markers of reflux and aspiration will be analyzed.

Retrospective Group: Up to 800 charts within the past 5 years will be reviewed for 1) subject outcome event rates for subjects with and without Gastroesophageal Reflux Disease (GERD) for survival, Bronchiolitis Obliterans Syndrome (BOS), acute rejection and Forced Expiratory Volume in the first second (FEV-1), 2) what is the estimated treatment effect of fundoplication on the above event rates, 3) is there a threshold effect such that events such as BOS and death are more likely to occur only at higher or more proximal acid or non-acid contact times. This review will better address the role of Gastroesophageal Reflux Disease (GERD) in lung allograft failure, the clinical utility of surgical fundoplication in preventing lung allograft injury, and the role that acid and non-acid reflux as related to aspiration causes lung allograft injury as it relates to a wider population.

Keywords
Lung Transplant, REflux Surgery, Gastroesophageal Reflux Disease (GERD), Fundoplication
Medical subject headings
Gastroesophageal Reflux

What participants receive

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

Study groups in NCT01406210
Study groupRoleWhat they receive
Prospective GroupThose patients that will be consented and data collected prospectively
Retrospective GroupThose charts that will be utilized to collect retrospective data, waiver of consent will be granted by the IRBs.

What is being measured

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

  1. BAL aspiration markers

    For the prospective study analysis, we will be assessing the relationship of gastroesophageal reflux and aspiration post lung transplantation with the occurrence of lung allograft dysfunction by reviewing BAL samples prospectively collected in approximately 125 subjects. These BAL samples will be assayed for bile acids; pepsin, pepsinogen I and II; trypsin; gastrin, and LPS content. The correlation of the aspiration biomarkers to acute rejection, BOS, death and FEV-1 at one year will be assessed.

    Measured: 1 year

  2. Death

    For the retrospective study, the first specific goal of data collection is outcome event rates for subjects with and without GERD for survival and the estimated treatment effect of fundoplication on the above event rates. A threshold effect for death is more likely to occur at higher or more proximal acid or non-acid contact times. Up to 5 years of follow-up data will be available for analysis with the primary comparison at one year. These data will be used to better design and coordinate a multicenter prospective study.

    Measured: 1 year

  3. BOS

    For the retrospective study, the second specific goal of data collection is event rates for subjects with and without GERD for BOS and the estimated treatment effect of fundoplication on the above event rates. A threshold effect for BOS is more likely to occur at higher or more proximal acid or non-acid contact times. Up to 5 years of follow-up data will be available for analysis with the primary comparison at one year. These data will be used to better design and coordinate a multicenter prospective study.

    Measured: 1 year

  4. FEV-1

    For the retrospective study, the third goal of data collection is evaluation of FEV-1 changes for subjects with and without GERD and the estimated treatment effect of fundoplication. Up to 5 years of follow-up data will be available for analysis with the primary comparison at one year. Data will be used to design a multicenter prospective study, address the role of GERD in lung allograft failure, the clinical utility of surgical fundoplication in preventing lung allograft injury, and the role that acid and non-acid reflux as related to aspiration causes lung allograft injury.

    Measured: 1 year

  5. Acute Rejection

    For the retrospective study, the final goal of data collection is evaluation of acute rejection episodes for subjects with and without GERD and the estimated treatment effect of fundoplication. Up to 5 years of follow-up data will be available for analysis with the primary comparison at one year. Data will be used to design a multicenter prospective study and to address the role of GERD in lung allograft failure, the clinical utility of surgical fundoplication in preventing lung allograft injury, and the role that acid and non-acid reflux as related to aspiration causes lung allograft injury.

    Measured: 1 year

Timeline

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

  1. First posted1 Aug 2011 (estimated)
  2. Study startSep 2011
  3. Primary completionJun 2013
  4. Study completionAug 2013

Resources

More details

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

Study design
Study type
Observational
Observational model
Case only
Enrolment
647 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01406210
Sponsor's protocol ID
Pro00025618
Other IDs
1R34HL105422-01
Acronym
RESULT
Status last verified
Sep 2014
First submitted
28 Jun 2011
Last updated
12 Sep 2014
Results posted
No
Data monitoring committee
No

Publications

  • Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, Mallory GB, Snell GI, Yousem S. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant. 2002 Mar;21(3):297-310. doi: 10.1016/s1053-2498(02)00398-4. No abstract available.

    PubMed 11897517
  • Cooper JD, Billingham M, Egan T, Hertz MI, Higenbottam T, Lynch J, Mauer J, Paradis I, Patterson GA, Smith C, et al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 1993 Sep-Oct;12(5):713-6.

    PubMed 8241207
  • Kroshus TJ, Kshettry VR, Savik K, John R, Hertz MI, Bolman RM 3rd. Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation. J Thorac Cardiovasc Surg. 1997 Aug;114(2):195-202. doi: 10.1016/S0022-5223(97)70144-2.

    PubMed 9270635
  • Heng D, Sharples LD, McNeil K, Stewart S, Wreghitt T, Wallwork J. Bronchiolitis obliterans syndrome: incidence, natural history, prognosis, and risk factors. J Heart Lung Transplant. 1998 Dec;17(12):1255-63.

    PubMed 9883768
  • McKane BW, Trulock EP, Patterson GA, Mohanakumar T. Lung transplantation and bronchiolitis obliterans: an evolution in understanding. Immunol Res. 2001;24(2):177-90. doi: 10.1385/IR:24:2:177.

    PubMed 11594455
  • Boehler A, Estenne M. Obliterative bronchiolitis after lung transplantation. Curr Opin Pulm Med. 2000 Mar;6(2):133-9. doi: 10.1097/00063198-200003000-00009.

    PubMed 10741773
  • Snell GI, Esmore DS, Williams TJ. Cytolytic therapy for the bronchiolitis obliterans syndrome complicating lung transplantation. Chest. 1996 Apr;109(4):874-8. doi: 10.1378/chest.109.4.874.

    PubMed 8635363
  • Kesten S, Rajagopalan N, Maurer J. Cytolytic therapy for the treatment of bronchiolitis obliterans syndrome following lung transplantation. Transplantation. 1996 Feb 15;61(3):427-30. doi: 10.1097/00007890-199602150-00019.

    PubMed 8610355
  • Speich R, Boehler A, Russi EW, Weder W. A case report of a double-blind, randomized trial of inhaled steroids in a patient with lung transplant bronchiolitis obliterans. Respiration. 1997;64(5):375-80. doi: 10.1159/000196708.

    PubMed 9311056
  • Iacono AT, Keenan RJ, Duncan SR, Smaldone GC, Dauber JH, Paradis IL, Ohori NP, Grgurich WF, Burckart GJ, Zeevi A, Delgado E, O'Riordan TG, Zendarsky MM, Yousem SA, Griffith BP. Aerosolized cyclosporine in lung recipients with refractory chronic rejection. Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1451-5. doi: 10.1164/ajrccm.153.4.8616581.

    PubMed 8616581
  • Dusmet M, Maurer J, Winton T, Kesten S. Methotrexate can halt the progression of bronchiolitis obliterans syndrome in lung transplant recipients. J Heart Lung Transplant. 1996 Sep;15(9):948-54.

    PubMed 8889991
  • Reichenspurner H, Meiser BM, Kur F, Wagner F, Welz A, Uberfuhr P, Briegel H, Reichart B. First experience with FK 506 for treatment of chronic pulmonary rejection. Transplant Proc. 1995 Jun;27(3):2009. No abstract available.

    PubMed 7540775
  • Kesten S, Chaparro C, Scavuzzo M, Gutierrez C. Tacrolimus as rescue therapy for bronchiolitis obliterans syndrome. J Heart Lung Transplant. 1997 Sep;16(9):905-12.

    PubMed 9322139
  • Speich R, Boehler A, Thurnheer R, Weder W. Salvage therapy with mycophenolate mofetil for lung transplant bronchiolitis obliterans: importance of dosage. Transplantation. 1997 Aug 15;64(3):533-5. doi: 10.1097/00007890-199708150-00027.

    PubMed 9275125
  • Whyte RI, Rossi SJ, Mulligan MS, Florn R, Baker L, Gupta S, Martinez FJ, Lynch JP 3rd. Mycophenolate mofetil for obliterative bronchiolitis syndrome after lung transplantation. Ann Thorac Surg. 1997 Oct;64(4):945-8. doi: 10.1016/s0003-4975(97)00845-x.

    PubMed 9354506

Questions about this trial

What is this clinical trial studying?

An observational study of Reflux and Gastroesophageal Reflux Disease (GERD), run by Duke University at 4 sites in 2 countries.

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 4 inclusion and 7 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 Sep 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States, Canada. 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?

BAL aspiration markers (time frame: 1 year). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01406210, which also lists 42 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 12 Sep 2014.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in