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Heart TransplantationPhase 2NCT03292861

The Effect and Safety Profile of Thymoglobulin® in Primary Cardiac Transplant Recipients

A Phase 2 study testing Thymoglobulin, Mycophenolate Mofetil and Tacrolimus in people with Heart Transplantation, run by Cedars-Sinai Medical Center at 2 sites in United States.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

This is a randomized, controlled, single center study to evaluate the efficacy of Thymoglobulin induction therapy in combination with Mycophenolate Mofetil, tacrolimus, and steroids in the prevention of CAV. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Heart Transplantation
What is being tested?
Thymoglobulin, Mycophenolate Mofetil and Tacrolimus
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
2 sitesUnited States
Study dates
13 Sep 2018to 31 Mar 2026
Phase
Phase 2
Are there results?
Not yet: the study is under way

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 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects must be undergoing their first allograft transplant
  • Men and non-pregnant women must be 18 to 70 years old
  • Women of childbearing potential must have a negative serum pregnancy test within 7 days prior to transplantation. The sensitivity must be equal to at least 50 mIU/mL. (Urine test is allowed in addition to serum test in patients where serum results are delayed)
  • Men with a female partner of child bearing age and women of childbearing potential must use two reliable forms of contraception simultaneously. Effective contraception must be used before beginning study drug therapy, and for 4 months following discontinuation of study drug therapy.
  • Subjects must be willing and capable of understanding the purpose and risks of the study, and must sign a statement of informed consent
  • Subjects with a Creatinine < 2.0 mg/dl at time of transplant

Who cannot join

  • Allergy to Thymoglobulin-Thymoglobulin is contraindicated in patients with history of allergy or anaphylaxis to rabbit proteins or to any product excipients, or who have active acute or chronic infections which contraindicate any additional immunosuppression
  • Previous organ transplants
  • Patients receiving multiple organs
  • Patients with a BMI higher than 35
  • Patients with PRA ≥ 25%
  • Patients requiring VAD upon completion of transplantation surgery.
Show all 12Show fewer
  • HIV-1, HTLV-1, chronic Hepatitis B, or chronic Hepatitis C infection
  • Documented or strong suspicion for pre-operative active infection that has not yet been adequately treated with the recommended course of antimicrobial therapy
  • Presence of any chronic myelosuppressive disease or agent that has resulted in either chronic leucopenia or chronic thrombocytopenia
  • Active peptic ulcer disease and active GI bleeding
  • Patients who have received within the past 30 days or require concomitant treatment with other investigational drugs (except for those listed in section 8.6 "Concomitant treatment")
  • Patients with a history of AL amyloidosis (TTR amyloids) are permitted

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

United States2 sites
  • Kaiser Permanente Los Angeles Medical Center

    Los Angeles, California, 90027

  • Cedars-Sinai Medical Center

    Los Angeles, California, 90048

Other trials in United States

About this study

Official title: A Pilot Randomized Study to Assess the Effect and Safety Profile of Thymoglobulin® in Primary Cardiac Transplant Recipients: A 12-month, Single Center, Randomized, Open-label Study of Efficacy Comparing Immediate Treatment With and Without Thymoglobulin® 1.5 mg/kg/d for 5 Consecutive Days in Heart Transplant Recipients

This is a randomized, controlled, single center study to evaluate the efficacy of Thymoglobulin induction therapy in combination with Mycophenolate Mofetil, tacrolimus, and steroids in the prevention of CAV. Approximately half of the patients will be randomized to receive a total of 5 doses of Thymoglobulin during the study. The first dose of Thymoglobulin will be administered at 1.5 mg/kg via intravenous infusion over 6 hours immediately upon arrival to the ICU post-operation (day 1). Subsequent doses of 1.5 mg/kg will be administered on days 2, 3, 4, and 5 via IV infusion over 4 hours.

Mechanistic assays (T-reg cells, Lym subsets, B cell subsets, IL-1b, cytokines, TGFb, IL-21 to be drawn at Pre-transplant, 3, 6, 12 months post-transplant) will also be performed.

All patients will be followed and monitored according to standard of care protocols for heart transplant recipients at our center.

Being tested
Thymoglobulin, Mycophenolate Mofetil, Tacrolimus, Sirolimus, Corticosteroids

What participants receive

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

  • ThymoglobulinDrug

    Approximately half of the patients will be randomized to receive a total of 5 doses of Thymoglobulin during the study. The first dose of Thymoglobulin will be administered at 1.5 mg/kg via intravenous infusion over 8 hours immediately upon arrival to the ICU post-operation (day 1). Subsequent doses of 1.5 mg/kg will be administered on days 2, 3, 4, and 5 via IV infusion over 4-8 hours.

  • Mycophenolate MofetilDrug

    3.0 grams divided bid begun post-transplant, either IV or po as tolerated by patient. Initial dose must be given within 24 hours post-transplant. Dosing will be titrated based on recipient's body size and any adverse side effects

  • TacrolimusDrug

    Doses of 1-4 mg bid either IV or po will be prescribed to achieve a target trough level of 10-15 ng/mL before post-operative day number 5. Target trough levels are 10-15 ng/mL for post-operative days #1-30, 8-12ng/mL days#31-60 and 5-10 ng/mL thereafter.

  • SirolimusDrug

    Maintenance doses of sirolimus at 12 months post-transplantation

  • CorticosteroidsDrug

    125 mg IV methylprednisolone immediately post-operatively x 3 doses q12hrs, then switching to oral prednisone at 1.0 mg/kg/day po divided into bid doses that are rounded off to the next higher 5 mg increment. For example, a 76 kg person would should be dosed at 38 mg po bid, which rounded off to the next 5 mg increment would be 40 mg po bid. (Equivalent dosing via an alternative route may be used if pos not tolerated or contraindicated). Prednisone will be tapered by 10 mg qd until the dose of 10 mg po bid is reached.

Study groups in NCT03292861
Study groupRoleWhat they receive
Thymoglobulin®Active comparatorThymoglobulin® (Genzyme) [rabbit anti-thymocyte globulin (ATG)] is a purified pasteurized, gamma immune globulin, obtained by immunization of rabbits with human thymocytes. This immunosuppressive product contains polyclonal cytotoxic antibodies directed against antigens expressed on human T-lymphocytes. Approximately half of the patients will be randomized to receive a total of 5 doses of Thymoglobulin during the study. The first dose of Thymoglobulin will be administered at 1.5 mg/kg via intravenous infusion over 6 hours immediately upon arrival to the ICU post-operation (day 1). Subsequent doses of 1.5 mg/kg will be administered on days 2, 3, 4, and 5 via IV infusion over 4 hours. In addition, there will be maintenance doses of mycophenolate mofetil, tacrolimus, sirolimus, and cumulative dose of corticosteroids at 12 months post-transplantation
Receives: Drug: Thymoglobulin; Drug: Mycophenolate Mofetil; Drug: Tacrolimus; Drug: Sirolimus; Drug: Corticosteroids
No induction therapyNo interventionPatients qualifying for the study will be randomized before the transplantation surgery in a 1:1 ratio to either Thymoglobulin® or no treatment.

What is being measured

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

  1. Percentage of Participants With Composite Efficacy Failure at 12 Months

    Composite efficacy failure is defined as development of de novo donor specific antibodies (measured by standardized alloantibody testing by Luminex and control sera, characterizing kinetics, specificities and relative binding strength) and ischemia on endomyocardial biopsy (characterized on biopsy by myocyte necrosis and/or regions of myocyte dropout) at 12 months post-transplant.

    Measured: 12 Months

Secondary outcomes (29)
  1. Changes in immune cell profiles

    Correlations between significant changes in immune cell profiles and biomarkers, and their relation to any significant differences in clinical outcomes

    Measured: 12 months

  2. Changes in biomarkers

    Correlations between significant changes in biomarkers and their relation to any significant differences in clinical outcomes

    Measured: 12 months

  3. Number of patients who experience rejection

    Number of patients who experience acute cellular, antibody-mediated, hemodynamic compromise, and any-treated rejection within first 12 months after transplantation/

    Measured: 12 months

  4. Number of episodes per patient

    Number of acute cellular, antibody-mediated, hemodynamic compromise and any-treated rejection episodes per patient within the first 12 months post-transplantation

    Measured: 12 months

  5. First rejection by ISHLT biopsy grading scale

    First acute cellular, antibody-mediated, hemodynamic compromise, and any-treated rejection by the ISHLT biopsy grading scale in the first 12 months post-transplantation

    Measured: 12 months

  6. Time to first rejection

    Time to first acute cellular, antibody-mediated, hemodynamic compromise, and any-treated rejection within the first 12 months

    Measured: 12 months

  7. Incidence of primary graft dysfunction (PGD)

    The incidence of Primary Graft Dysfunction(PGD) in the first 24 hours post-transplant

    Measured: first 24 hours post-transplant

  8. Patient and graft survival

    Patient and graft survival at 12 months post-transplantation

    Measured: 12 months

  9. Types of patients with fatal infectious complications

    The types of patients with fatal infectious complications (especially CMV infection) within the first 12 months post-transplantation

    Measured: 12 months

  10. Number of patients with fatal infectious complications

    The number of patients with fatal infectious complications (especially CMV infection) within the first 12 months post-transplantation

    Measured: 12 months

  11. Types of patients with non-fatal infectious complications

    Types of patients with non-fatal infectious complications (especially CMV infection) within the first 12 months post-transplantation

    Measured: 12 months

  12. Number of patients with non-fatal infectious complications

    Number of patients with non-fatal infectious complications (especially CMV infection) within the first 12 months post-transplantation

    Measured: 12 months

  13. Freedom from development of circulating antibodies

    Freedom from the development of circulating antibodies within the first 12 months post transplantation, where circulating antibodies include donor specific antibodies (DSA), non-specific antibodies, and non-human leukocyte antigen antibodies

    Measured: 12 months

  14. Change in coronary maximal intimal thickness

    Change in coronary maximal intimal thickness at matched sites by intravascular ultrasound at 12 months

    Measured: 12 months

  15. Change in coronary intimal area

    Change in coronary intimal area at matched sites by intravascular ultrasound at 12 months

    Measured: 12 months

  16. Change in coronary intimal volume

    Change in coronary intimal volume at matched sites by intravascular ultrasound at 12 months

    Measured: 12 months

  17. Change in coronary vessel area

    Change in coronary vessel area at matched sites by intravascular ultrasound at 12 months

    Measured: 12 months

  18. Change in coronary intimal index

    Change in coronary intimal index at matched sites by intravascular ultrasound at 12 months

    Measured: 12 months

  19. Change in coronary percent atheroma volume

    Change in coronary percent atheroma volume at matched sites by intravascular ultrasound at 12 months

    Measured: 12 months

  20. Maintenance doses of mycophenolate mofetil, tacrolimus, sirolimus, and dose of corticosteroids

    Maintenance doses of mycophenolate mofetil, tacrolimus, sirolimus, and cumulative dose of corticosteroids at 12 months post-transplantation

    Measured: 12 months

  21. Number of hospital days per patient

    Number of hospital days per patient, both during the transplant period and during the post-transplant period at 3 months, 6 months, and 1 year

    Measured: 3 months, 6 months, 12 months

  22. Number of patients requiring hospitalization

    Number of patients requiring hospitalization by 3 months, by 6 months, or by 1 year post-transplantation

    Measured: 3 months, 6 months, 12 months

  23. Death/Re-transplant

    To describe between treatment groups the incidence of the composite primary endpoint of death/re-transplant at 12 months post-transplantation

    Measured: 12 months

  24. Hemodynamic compromise rejection

    To describe between treatment groups the incidence of the composite primary endpoint of hemodynamic compromise rejection at 12 months post-transplantation. This is an ejection fraction of ≤ 30% or a 0.20 absolute decrease from baseline, and the need for inotropic agents OR a fractional shortening ≤ 20% or a 25% decrease from baseline, and the need for inotropic agents PLUS need for inotropic agents due to a Cardiac Index (CI) < 2.0 L/min/m2 or a 25% decrease from baseline

    Measured: 12 months

  25. Graft dysfunction

    To describe between treatment groups the incidence of the composite primary endpoint of graft dysfunction (ejection fraction less than or equal to 40% by echocardiography)at 12 months post-transplantation

    Measured: 12 months

  26. Cellular rejection

    To describe between treatment groups the incidence of the composite primary endpoint of biopsy proven cellular rejection ≥2R at 12 months post-transplantation

    Measured: 12 months

  27. Antibody mediated rejected

    To describe between treatment groups the incidence of the composite primary endpoint of biopsy proven antibody mediated rejection ≥AMR1 at 12 months post-transplantation

    Measured: 12 months

  28. Cardiac Allograft Vasculopathy (CAV)

    To describe between treatment groups the incidence of cardiac allograft vasculopathy (CAV) (defined as a change ≥0.5mm in maximal intimal thickness (MIT) of the coronary arteries by intravascular ultrasound at 12 months as compared to baseline)

    Measured: 12 months

  29. Any treated rejection

    To describe between treatment groups any treated rejection at 12 months

    Measured: 12 months

Timeline

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

  1. First posted26 Sep 2017
  2. Study start13 Sep 2018
  3. Primary completion31 Mar 2026 (estimated)
  4. Study completion31 Mar 2026 (estimated)

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
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03292861
Sponsor's protocol ID
ATG Pilot Study
Status last verified
Jan 2026
First submitted
12 Sep 2017
Last updated
14 Jan 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Thymoglobulin, Mycophenolate Mofetil and Tacrolimus in people with Heart Transplantation, run by Cedars-Sinai Medical Center at 2 sites 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 6 inclusion and 12 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: enrolling by invitation, as of the sponsor's last update on 14 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites 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.

What does this 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.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

Percentage of Participants With Composite Efficacy Failure at 12 Months (time frame: 12 Months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 14 Jan 2026.

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