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Kidney Transplant RejectionTTIPSNCT05335538

TruGraf and TRAC In Pediatrics Study

An observational study of Kidney Transplant Rejection, run by Transplant Genomics, Inc. at 3 sites in 2 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This is a pilot 3 center prospective study of pediatric renal kidney recipients undergoing protocol biopsies examining the performance of the TruGraf gene expression test in children and adolescents. Read more about this study

Who is it for?
Ages 1 year to 18 years
Conditions the study is for
Kidney Transplant Rejection
What is being tested?
Patients monitored with TruGraf and TRAC testing
How many people
75 participants
Where
3 sitesin 2 countries
Study dates
30 Nov 2021to 1 Mar 2023
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 1 year to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Study population: Renal transplant pediatric patients age 1 to 18 years old who must be undergoing a protocol biopsy.

Who may be able to join

  • Patients aged 1-≤ 18 years and recipients of either living or deceased donor transplants Undergoing a protocol biopsy at either 3, 6, 12, 24 or 36 months
  • Serum creatinine at the time of the clinic visit prior to the scheduled biopsy within 30% of a baseline calculated as the mean of the recipient's last 3 serum creatinine levels
  • Serum creatinine level at the time of protocol biopsy ≤ 1.7 mg/dl.
  • Patient receiving immunosuppression with a calcineurin inhibitor (either tacrolimus or cyclosporine) and/or an antimetabolite (either mycophenolate mofetil, mycophenolic acid EC or azathioprine) and/or an mTOR inhibitor (either sirolimus or everolimus) and/or corticosteroids.
  • Absence of any systemic or urinary bacterial, viral or fungal infection
  • Absence of significant BK viremia (as determined by the laboratory where the determination is run) at the time of the last clinical determination and at the time of the protocol biopsy
  • Parents or guardians are capable of reading and understanding the Informed Consent document and willing to participate; if appropriate, patient is also able to understand the Informed Consent. If patient is older than 13 years, patient should be able to give Assent as written on Assent Form.
  • For females of child-bearing age, a negative pregnancy test within 6 weeks of the protocol biopsy.

Who cannot join

  • Refusal to undergo clinical standard-of-care protocol biopsy by either parent/guardian or patient.
  • Inability to obtain adequate tissue on protocol biopsy
  • Current participation in another interventional research study; patients who have completed the drug in another interventional study are eligible if they meet all other inclusion criteria.
  • Serum creatinine at the clinic visit prior to the biopsy is > 30% of a baseline calculated as the mean of the recipient's last 3 serum creatinine levels.
  • Serum creatinine at the time of the protocol biopsy ≥ 1.8 mg/dl. If the patient had a baseline < 1.8, and the creatinine on the day of biopsy is ≥ 1.8, at the discretion of the PI, the patient will be instructed to hydrate for 4 days and a serum creatinine will be obtained at that time. This is standard clinical practice. If the creatinine returns to the baseline (i.e., ≤ 30%) range, the patient will be classified as having stable renal function, while if the patient's serum creatinine does not return to the ≤ 30% range, he/she will be classified as having renal dysfunction
  • Patients who, in the estimation of the investigator, are undergoing "for-cause" biopsies.
Show all 14Show fewer
  • Presence of any current and active bacterial, viral or fungal infection
  • Presence of BK viremia judged to be significant by the site PI.
  • Presence of BK nephropathy
  • History of PTLD or malignancy
  • Parents / guardians do not understand Informed Consent and / or are unwilling to participate; patient, if of appropriate age, is unwilling to participate
  • Patients manifesting recurrent disease in their transplant (such as FSGS/nephrotic syndrome, C3 Glomeruopathy, MPGN, hyperoxaluria)
  • Abnormal proteinuria as determined by a urinary protein: creatinine ratio of >1.
  • Recipients of multi-organ transplants.

Trial locations and contacts

3 sites in 2 countries.

3 sites in 2 countries

United States2 sites, 2 recruiting
  • The University of Alabama at Birmingham

    Birmingham, Alabama, 35294

    Michael Seifert, MD, mseifert@peds.uab.edu

    Recruiting
  • UCLA Mattel Children's Hospital

    Los Angeles, California, 90095

    Robert Ettenger, MD, REttenger@mednet.ucla.edu

    Recruiting

Other trials in United States

Canada1 site, 1 recruiting
  • British Columbia Children's Hospital

    Vancouver

    Tom Blydt-Hansen, MD, tom.blydthansen@cw.bc.ca

    Recruiting

Other trials in Canada

About this study

Official title: The Role of TruGraf® to Optimize Outcomes in Pediatric Renal Transplantation

This is a pilot 3 center prospective study of pediatric renal kidney recipients undergoing protocol biopsies examining the performance of the TruGraf gene expression test in children and adolescents.

Read the detailed description

In pediatric renal transplant recipients, subclinical rejection in protocol biopsies is associated with a significantly increased incidence of acute rejection and/or allograft loss at 5 years post-transplant. Currently, TruGraf is the only noninvasive test designed and validated in adult kidney transplant recipients for use in ruling out silent subacute rejection in that has been approved by Medicare as an alternative to surveillance biopsies. The first step to the use of TruGraf in pediatrics is to perform a validation study in children and adolescents. Specifically, if validated in children and adolescents, a TruGraf result would enable a pediatric transplant physician to identify patients in whom no intervention is necessary without the need of a protocol biopsy. Therefore the aim of this study is to examine the concordance between the results of the TruGraf tests and protocol biopsies taken from stable pediatric renal transplant patients concurrently.

Being tested
Patients monitored with TruGraf and TRAC testing
Keywords
Biomarkers, Subclinical Rejection, Biopsy

What participants receive

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

  • Patients monitored with TruGraf and TRAC testingDiagnostic test

    This is an observational study there are no protocol mandated interventions. TruGraf and TRAC results will be utilized in conjunction with standard of care assessments to determine patient management.

What is being measured

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

  1. Concordance of Biomarkers with protocol biopsy

    Examination of the concordance between the results of the TruGraf tests and protocol biopsies taken from stable pediatric renal transplant concurrently.

    Measured: 1 year

Secondary outcomes (6)
  1. Concordance between the results of the TruGraf test and the histological finding of borderline changes vs. TCMR vs. AMR.

    Separately examine the concordance between the results of the TruGraf test and the histological finding of borderline changes vs. TCMR vs. AMR.

    Measured: 1 year

  2. Compare TruGraf results in patients ≤ 11 years old vs ≥ 12 years old

    Compare the agreement between protocol biopsies and TruGraf results in patients ≤ 11 years old vs ≥ 12 years old

    Measured: 1 year

  3. Relationship between de novo DSA, a normal protocol biopsy and the TruGraf result.

    Assess the relationship, if any, between the appearance of de novo DSA, a normal protocol transplant biopsy and the TruGraf result.

    Measured: 1 year

  4. Examine TruGraf results and the %CV tacrolimus levels- index of medication nonadherence.

    Examine the relationship between the TruGraf results and the %CV tacrolimus levels as an index of medication nonadherence.

    Measured: 1 year

  5. Relationship between urinary CXCL10 and subclinical rejection affecting the predictive value of TruGraf.

    Examine the relationship between urinary CXCL10 and subclinical rejection in this patient cohort to examine whether it improves the performance metrics by improving the negative or positive predictive of TruGraf.

    Measured: 1 year

  6. Examine relationship between ddcfDNA and subclinical rejection

    Examine the relationship between ddcfDNA and subclinical rejection in this patient cohort

    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 posted19 Apr 2022
  2. Study start30 Nov 2021
  3. Primary completion30 Dec 2022 (estimated)
  4. Study completion1 Mar 2023 (estimated)

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
Cohort
Time perspective
Prospective
Enrolment
75 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05335538
Sponsor's protocol ID
TGRP08
Acronym
TTIPS
Status last verified
Aug 2021
First submitted
12 Apr 2022
Last updated
19 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Moudgil A, Dharnidharka VR, Lamb KE, Meier-Kriesche HU. Best allograft survival from share-35 kidney donors occurs in middle-aged adults and young children-an analysis of OPTN data. Transplantation. 2013 Jan 27;95(2):319-25. doi: 10.1097/TP.0b013e3182719203.

    PubMed 23154211
  • Horslen S, Barr ML, Christensen LL, Ettenger R, Magee JC. Pediatric transplantation in the United States, 1996-2005. Am J Transplant. 2007;7(5 Pt 2):1339-58. doi: 10.1111/j.1600-6143.2007.01780.x.

    PubMed 17428284
  • Verghese PS. Pediatric kidney transplantation: a historical review. Pediatr Res. 2017 Jan;81(1-2):259-264. doi: 10.1038/pr.2016.207. Epub 2016 Oct 12.

    PubMed 27732587
  • United States Renal Data System 2018 Annual Data Report Volume 2 ESRD Chapter 5

  • Aubert O, Loupy A, Hidalgo L, Duong van Huyen JP, Higgins S, Viglietti D, Jouven X, Glotz D, Legendre C, Lefaucheur C, Halloran PF. Antibody-Mediated Rejection Due to Preexisting versus De Novo Donor-Specific Antibodies in Kidney Allograft Recipients. J Am Soc Nephrol. 2017 Jun;28(6):1912-1923. doi: 10.1681/ASN.2016070797. Epub 2017 Mar 2.

    PubMed 28255002
  • Ettenger R, Albrecht R, Alloway R, Belen O, Cavaille-Coll MW, Chisholm-Burns MA, Dew MA, Fitzsimmons WE, Nickerson P, Thompson G, Vaidya P. Meeting report: FDA public meeting on patient-focused drug development and medication adherence in solid organ transplant patients. Am J Transplant. 2018 Mar;18(3):564-573. doi: 10.1111/ajt.14635. Epub 2018 Jan 25.

    PubMed 29288623
  • Birk PE. Surveillance biopsies in children post-kidney transplant. Pediatr Nephrol. 2012 May;27(5):753-60. doi: 10.1007/s00467-011-1969-8. Epub 2011 Jul 27.

    PubMed 21792611
  • Gordillo R, Munshi R, Monroe EJ, Shivaram GM, Smith JM. Benefits and risks of protocol biopsies in pediatric renal transplantation. Pediatr Nephrol. 2019 Apr;34(4):593-598. doi: 10.1007/s00467-018-3959-6. Epub 2018 May 3.

    PubMed 29725772
  • Nazario M, Nicoara O, Becton L, Self S, Hill J, Mack E, Evans M, Twombley K. Safety and utility of surveillance biopsies in pediatric kidney transplant patients. Pediatr Transplant. 2018 Jun;22(4):e13178. doi: 10.1111/petr.13178. Epub 2018 Mar 27.

    PubMed 29582530
  • Rush D. Protocol biopsies should be part of the routine management of kidney transplant recipients. Pro. Am J Kidney Dis. 2002 Oct;40(4):671-3. doi: 10.1053/ajkd.2002.36427. No abstract available.

    PubMed 12324898
  • Rose EM, Kennedy SE, Mackie FE. Surveillance biopsies after paediatric kidney transplantation: A review. Pediatr Transplant. 2016 Sep;20(6):748-55. doi: 10.1111/petr.12733. Epub 2016 Jun 16.

    PubMed 27306873
  • Birk PE, Stannard KM, Konrad HB, Blydt-Hansen TD, Ogborn MR, Cheang MS, Gartner JG, Gibson IW. Surveillance biopsies are superior to functional studies for the diagnosis of acute and chronic renal allograft pathology in children. Pediatr Transplant. 2004 Feb;8(1):29-38. doi: 10.1046/j.1397-3142.2003.00122.x.

    PubMed 15009838
  • Furness PN, Philpott CM, Chorbadjian MT, Nicholson ML, Bosmans JL, Corthouts BL, Bogers JJ, Schwarz A, Gwinner W, Haller H, Mengel M, Seron D, Moreso F, Canas C. Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation. 2003 Sep 27;76(6):969-73. doi: 10.1097/01.TP.0000082542.99416.11.

    PubMed 14508363
  • Nankivell BJ, Agrawal N, Sharma A, Taverniti A, P'Ng CH, Shingde M, Wong G, Chapman JR. The clinical and pathological significance of borderline T cell-mediated rejection. Am J Transplant. 2019 May;19(5):1452-1463. doi: 10.1111/ajt.15197. Epub 2019 Jan 22.

    PubMed 30501008
  • Seifert ME, Yanik MV, Feig DI, Hauptfeld-Dolejsek V, Mroczek-Musulman EC, Kelly DR, Rosenblum F, Mannon RB. Subclinical inflammation phenotypes and long-term outcomes after pediatric kidney transplantation. Am J Transplant. 2018 Sep;18(9):2189-2199. doi: 10.1111/ajt.14933. Epub 2018 Jun 27.

    PubMed 29766640

Questions about this trial

What is this clinical trial studying?

An observational study of Kidney Transplant Rejection, run by Transplant Genomics, Inc. at 3 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 8 inclusion and 14 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: status not confirmed, as of the sponsor's last update on 19 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 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?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Cortney Miller, PhD (5107753326, cortneymiller@eurofins-tgi.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Concordance of Biomarkers with protocol biopsy (time frame: 1 year). 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 NCT05335538, which also lists 62 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 19 Apr 2022.

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