Spatial Transcriptomics in Kidney Transplantation (SPACE-KiT)

Western Sydney Local Health District

Status: Invitation-only

Conditions: Transplant Complication; Kidney Injury

Treatments: Other: Non interventional

Study type: Observational

Funder types: Other

Identifiers

NCT06288425

SPACE-KIT

Details and patient eligibility

About

The study is an investigator-led, prospective, longitudinal, observational cohort study.

The central hypothesis for this study is that spatial data will reveal new insights to immune cell function and local interactions within the kidney tissue to better predict important clinical outcomes. Investigators aspire to establish a prospective, longitudinal cohort to improve the diagnosis and management of kidney transplant rejection using precision pathology.

By utilising new spatial technologies, the investigators aim to:

• Derive a spatially resolved transcriptomic signature of kidney transplant rejection subtypes
• Derive accurate transcriptomic signatures aligned with key cell types within the transplant kidney
• Develop refinements to histological kidney rejection diagnostic and scoring classification
• Correlate of spatial and refined biopsy scoring features to clinically important outcomes

Full description

Primary outcomes: The correlation of kidney transplant rejection subtypes with transcriptomic, spatial and cell-type features

Secondary outcomes: Correlation of the refined biopsy scoring criteria and transcriptomics signatures with:

1. All cause graft loss
2. Death censored graft loss
3. Treatment resistant rejection
4. Delayed graft function (DGF)
5. Biopsy evidence of borderline rejection based on current Banff scoring system
6. Biopsy proven acute rejection - T-cell mediated (TCMR), antibody-mediated (ABMR), mixed
7. Chronic rejection - acute or inactive
8. Interstitial fibrosis scores (IFTA) on kidney biopsy on any biopsies
9. Chronic transplant glomerulopathy on kidney biopsy on any biopsies
10. Development of BK virus associated nephropathy at any time
11. Recurrent disease (original cause of kidney failure) post transplantation at any time
12. Kidney function with serum creatinine, estimated or measured glomerular filtration rate (GFR)
13. Development of albuminuria
14. Surrogate end-points - eGFR slope and iBOX(TM) score
15. Donor-recipient HLA and non-HLA genomic mismatches
16. Recipient proteinomic expression profile

Enrollment: 500 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

All participants included in the study must be age ≥ 18 years old at time of enrolment and

1. able to provide informed consent (interpreter permitted) for enrolment
2. consenting to longitudinal follow up (can withdraw post enrolment)
3. consenting to provide samples for biobanking, including blood, urine, faecal and/or kidney biopsy tissue (collected prospectively, separate to routine care)

Exclusion criteria

Patients will be excluded from the study if they are

1. unable (or unwilling) to provide consent, or
2. have life-expectancy less than 6-months, or
3. have received a haematopoietic stem cell transplant in the past 5 years.

Trial design

500 participants in 8 patient groups

No rejection, normal biopsy (controls)

Description:

Normal biopsy - no acute tubular injury (ATI), rejection or any other pathology

Treatment:

Other: Non interventional

Acute kidney injury without evidence of rejection

Description:

Biopsy features of acute tubular injury but no evidence of rejection

Treatment:

Other: Non interventional

Subclinical Rejection

Description:

Biopsy features of injury and inflammation but not meeting current diagnostic criteria for acute or chronic rejection

Treatment:

Other: Non interventional

Acute rejection

Description:

Biopsy features of T-cell mediated, antibody-mediated, or mixed rejection

Treatment:

Other: Non interventional

Isolated vascular rejection

Description:

Biopsy features of inflammation in the blood vessels only

Treatment:

Other: Non interventional

Isolated glomerulitis

Description:

Biopsy features of inflammation in the glomeruli only

Treatment:

Other: Non interventional

Chronic (active) rejection

Description:

Biopsy features of chronic rejection - T-cell, antibody or mixed types

Treatment:

Other: Non interventional

BK virus associated nephropathy (BKVAN)

Description:

Biopsy features of SV40 positive staining in tubules to diagnose BKVAN

Treatment:

Other: Non interventional