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Kidney Transplant; ComplicationsPhase 2/3NCT03206801

Urine CXCL10 Monitoring Trial in Kidney Transplant

A Phase 2/3 study testing Kidney transplant biopsy in people with Kidney Transplant; Complications and Rejection of Renal Transplant, run by University of Manitoba at 9 sites in 2 countries.

Completed

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

Official record
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Trial summary

This is a Phase II-III multi-center prospective randomized controlled clinical trial of incident adult renal transplant patients. The primary objective of this study is to determine if the early treatment of rejection, as detected by urinary CXCL10, will improve renal allograft outcomes. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Kidney transplant biopsy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
260 participants
Where
9 sitesin 2 countries
Study dates
3 Apr 2018to 26 Sep 2025
Phase
Phase 2/3
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

  • Participants must be able to understand and provide written informed consent
  • Stated willingness to comply with all study procedures and availability for the duration of the study
  • All ethnic and gender groups will have equal access to the study
  • Incident adult (age ≥18) renal transplant patients with a living or deceased donor kidney transplant
  • Confirmed elevated urine CXCL10:Cr without a urinary tract infection or gross hematuria.

Who cannot join

  • Primary non-function
  • Blood group (ABO) incompatible
  • Pre-transplant donor specific antibody (DSA) positive (MFI>1000 OR positive flow crossmatch)
  • Human leukocyte (HLA) 0 HLA antigen D-related (DR) + 0 major HLA class 2 (DQ) mismatch
  • Presence of other transplanted organ or co-transplanted organ
  • Medical contraindication to biopsy or rejection treatment
Show all 10Show fewer
  • Followed outside of investigational center
  • Participation in other interventional trials within 4-weeks post-transplant or anytime post-transplant till study end at 12-months
  • Intention to not use a maintenance immunosuppression regimen consisting of calcineurin inhibitor (CNI) and anti-proliferative agents
  • Any condition that, in the opinion of the investigator, would pose risk to the subject's safe participation, or interfere with their ability to comply with the study requirements, or may impact the quality of interpretation of the data.

Trial locations and contacts

9 sites in 2 countries.

9 sites in 2 countries

Canada8 sites
  • University of Calgary

    Calgary, Alberta

  • Western University

    London, Ontario

  • Centre de recherche du CHUM (CRCHUM)

    Montreal, Quebec

  • McGill

    Montreal, Quebec

  • University of Ottawa

    Ottawa, Ontario

  • Université Laval

    Québec, Quebec

  • University Health Network, University of Toronto

    Toronto, Ontario

  • University of Manitoba, Transplant Manitoba Adult Kidney Program

    Winnipeg, Manitoba, R3A 1R9

Other trials in Canada

Australia1 site
  • Royal Adelaide Hospital

    Adelaide, South Australia, 5000

Other trials in Australia

About this study

Official title: A Randomized Controlled Trial of Urine CXCL10 Chemokine Monitoring Post-renal Transplant

This is a Phase II-III multi-center prospective randomized controlled clinical trial of incident adult renal transplant patients.

The primary objective of this study is to determine if the early treatment of rejection, as detected by urinary CXCL10, will improve renal allograft outcomes.

Read the detailed description

This is a Phase II-III multi-center prospective randomized controlled clinical trial of incident adult renal transplant patients. Patients will be screened for eligibility (n≈485) and n≈420 will be enrolled and undergo post-transplant surveillance with urinary CXCL10. Two hundred and fifty patients deemed at high risk for rejection based on a confirmed elevated urine CXCL10 will undergo 1:1 randomization to the intervention and control arms, stratified by center. The total study duration is approximately 5 years; and there two main phases - screening and intervention.

All eligible, enrolled patients will undergo the Screening Phase (n≈420). Routine urine CXCL10 screening will be done from 2 weeks - 9 months post-transplant. We have previously shown that urine CXCL10 is elevated in ischemia-reperfusion injury, so screening will commence at 2 weeks (+/- 4 days) to exclude this as a potential confounding factor (60).

If patient develops a confirmed elevated urine CXCL10 level and is considered high risk for rejection, they will proceed to Randomization in the Intervention Phase, which can occur anytime between 2 weeks - 9 months post-transplant. Participants in the Intervention Arm will undergo renal biopsy to check for rejection. Biopsy-proven subclinical rejection will be treated per study protocol. Participants in the Control Arm will continue routine post-transplant surveillance with serum creatinine and proteinuria; serial urine samples will continue to be collected and analyzed (blinded), but not used to direct care. All randomized participants will undergo a 12-month study exit visit with protocol biopsy to determine primary, secondary and long-term outcomes.

Enrolled patients with persistently low urine CXCL10 and low risk of rejection from 2 weeks - 9 months post-transplant will be considered Off-Study (not randomized). They will undergo a 12-month study exit visit (+/- 7 days) to determine secondary and long-term outcomes.

Being tested
Kidney transplant biopsy
Keywords
Urine biomarker, CXCL10 chemokine, Post-transplant monitoring, Protocol biopsy

What participants receive

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

  • Kidney transplant biopsyProcedure or surgery

    Also called Protocol biopsy

    Elevated urine CXCL10 will trigger a study biopsy in patients randomized to the intervention arm. Subclinical rejection will be treated per protocol.

Study groups in NCT03206801
Study groupRoleWhat they receive
InterventionExperimentalParticipants with high urine CXCL10 randomized to the Intervention Arm will undergo a kidney transplant biopsy to check for rejection. Biopsy-proven subclinical rejection will be treated per study protocol.
Receives: Procedure: Kidney transplant biopsy
ControlNo interventionParticipants with high urine CXCL10 randomized to the Control Arm will continue routine post-transplant surveillance with serum creatinine and proteinuria; serial urine samples will continue to be collected and analyzed (blinded), but not used to direct care.

What is being measured

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

  1. Death-censored graft loss

    Return to dialysis or re-transplant

    Measured: 2 weeks-12 months post-transplant

  2. Clinical indication biopsy-proven acute rejection

    Clinical rejection, Banff criteria

    Measured: 2 weeks-12 months post-transplant

  3. De novo donor specific antibody development

    De novo human leukocyte antibody (HLA) antibodies, donor specific

    Measured: 2 weeks-12 months post-transplant

  4. Subclinical tubulitis

    Subclinical rejection, Banff criteria

    Measured: 12-month study exit biopsy

  5. Interstitial fibrosis and inflammation (IFTA + i)

    IFTA + i, defined by Mayo criteria

    Measured: 12-month study exit biopsy

Secondary outcomes (8)
  1. Renal allograft function

    Change in eGFR (slope, ∆) and graft function (eGFR) (absolute, mL/min)

    Measured: 6, 12, 24 and 60 months post-transplant

  2. Microvascular inflammation

    Banff ptc, g, c4d, cg

    Measured: 12-month study exit biopsy

  3. Development IFTA from implantation to 12-months

    Banff ∆ ci, ct, cv

    Measured: 12-month study exit biopsy

  4. Days from transplantation to clinical-biopsy proven rejection

    Time to biopsy proven rejection

    Measured: 2 weeks-12 months post-transplant

  5. Albuminuria >300mg/day

    Urine albumin: Cr ratio

    Measured: 6, 12, 24 and 60 months post-transplant

  6. Cost-effectiveness of urine CXCL10 monitoring strategy

    Costs of urine CXCL10 screening

    Measured: 2 weeks-12 months post-transplant

  7. Quality of life

    EuroQOL (EQ-5DL)

    Measured: 6 and 12 months post-transplant

  8. Urine CXCL10 kinetics

    Change in urine CXCL10 levels in response to rejection therapy

    Measured: 2 weeks-12 months post-transplant

Timeline

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

  1. First posted2 Jul 2017
  2. Study start3 Apr 2018
  3. Primary completion6 Jun 2025
  4. Study completion26 Sep 2025

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 2/3
Primary purpose
Screening
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a Phase II-III multi-center prospective randomized controlled clinical trial of incident adult renal transplant patients. Patients with elevated urine CXCL10 will be randomized 1:1 to the intervention and control arms, stratified by center (\~ 420 enrolled to urine CXCL10 screening for n=250 randomized participants).
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
260 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03206801
Sponsor's protocol ID
B2017:076
Other IDs
364003, TMCT-04
Status last verified
Apr 2026
First submitted
28 Jun 2017
Last updated
5 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Ho J, Rush DN, Karpinski M, Storsley L, Gibson IW, Bestland J, Gao A, Stefura W, HayGlass KT, Nickerson PW. Validation of urinary CXCL10 as a marker of borderline, subclinical, and clinical tubulitis. Transplantation. 2011 Oct 27;92(8):878-82. doi: 10.1097/TP.0b013e31822d4de1.

    PubMed 21876477
  • Hirt-Minkowski P, Amico P, Ho J, Gao A, Bestland J, Hopfer H, Steiger J, Dickenmann M, Burkhalter F, Rush D, Nickerson P, Schaub S. Detection of clinical and subclinical tubulo-interstitial inflammation by the urinary CXCL10 chemokine in a real-life setting. Am J Transplant. 2012 Jul;12(7):1811-23. doi: 10.1111/j.1600-6143.2012.03999.x. Epub 2012 Mar 5.

    PubMed 22390571
  • Blydt-Hansen TD, Gibson IW, Gao A, Dufault B, Ho J. Elevated urinary CXCL10-to-creatinine ratio is associated with subclinical and clinical rejection in pediatric renal transplantation. Transplantation. 2015 Apr;99(4):797-804. doi: 10.1097/TP.0000000000000419.

    PubMed 25222013
  • Hirt-Minkowski P, Ho J, Gao A, Amico P, Koller MT, Hopfer H, Rush DN, Nickerson PW, Schaub S. Prediction of Long-term Renal Allograft Outcome By Early Urinary CXCL10 Chemokine Levels. Transplant Direct. 2015 Sep 24;1(8):e31. doi: 10.1097/TXD.0000000000000537. eCollection 2015 Sep.

    PubMed 27500231
  • Hirt-Minkowski P, Rush DN, Gao A, Hopfer H, Wiebe C, Nickerson PW, Schaub S, Ho J. Six-Month Urinary CCL2 and CXCL10 Levels Predict Long-term Renal Allograft Outcome. Transplantation. 2016 Sep;100(9):1988-96. doi: 10.1097/TP.0000000000001304.

    PubMed 27548845
  • Ho J, Sharma A, Mandal R, Wishart DS, Wiebe C, Storsley L, Karpinski M, Gibson IW, Nickerson PW, Rush DN. Detecting Renal Allograft Inflammation Using Quantitative Urine Metabolomics and CXCL10. Transplant Direct. 2016 May 19;2(6):e78. doi: 10.1097/TXD.0000000000000589. eCollection 2016 Jun.

    PubMed 27500268
  • Ho J, Rush DN, Krokhin O, Antonovici M, Gao A, Bestland J, Wiebe C, Hiebert B, Rigatto C, Gibson IW, Wilkins JA, Nickerson PW. Elevated Urinary Matrix Metalloproteinase-7 Detects Underlying Renal Allograft Inflammation and Injury. Transplantation. 2016 Mar;100(3):648-54. doi: 10.1097/TP.0000000000000867.

    PubMed 26906940
  • Hricik DE, Nickerson P, Formica RN, Poggio ED, Rush D, Newell KA, Goebel J, Gibson IW, Fairchild RL, Riggs M, Spain K, Ikle D, Bridges ND, Heeger PS; CTOT-01 consortium. Multicenter validation of urinary CXCL9 as a risk-stratifying biomarker for kidney transplant injury. Am J Transplant. 2013 Oct;13(10):2634-44. doi: 10.1111/ajt.12426. Epub 2013 Aug 22.

    PubMed 23968332
  • Rabant M, Amrouche L, Lebreton X, Aulagnon F, Benon A, Sauvaget V, Bonifay R, Morin L, Scemla A, Delville M, Martinez F, Timsit MO, Duong Van Huyen JP, Legendre C, Terzi F, Anglicheau D. Urinary C-X-C Motif Chemokine 10 Independently Improves the Noninvasive Diagnosis of Antibody-Mediated Kidney Allograft Rejection. J Am Soc Nephrol. 2015 Nov;26(11):2840-51. doi: 10.1681/ASN.2014080797. Epub 2015 May 6.

    PubMed 25948873
  • Ho J, Sharma A, Kroeker K, Carroll R, De Serres S, Gibson IW, Hirt-Minkowski P, Jevnikar A, Kim SJ, Knoll G, Rush DN, Wiebe C, Nickerson P. Multicentre randomised controlled trial protocol of urine CXCL10 monitoring strategy in kidney transplant recipients. BMJ Open. 2019 Apr 11;9(4):e024908. doi: 10.1136/bmjopen-2018-024908.

    PubMed 30975673

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Kidney transplant biopsy in people with Kidney Transplant; Complications and Rejection of Renal Transplant, run by University of Manitoba at 9 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 5 inclusion and 10 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 5 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in Canada, Australia. 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.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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?

Death-censored graft loss (time frame: 2 weeks-12 months post-transplant). 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 NCT03206801, which also lists 10 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 5 May 2026.

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