Trial of Calcineurin Inhibitor-Sparing Immunosuppression Regimen in Pediatric Liver Transplantation

Baylor College of Medicine

Status and phase: Terminated; Phase 4

Conditions: Renal Failure; Renal Insufficiency; End-stage Liver Disease

Treatments: Other: placebo medication; Drug: mycophenolate mofetil

Study type: Interventional

Funder types: Other

Identifiers

NCT00656266

H-15138

Details and patient eligibility

About

The objective of this study is to compare the effects of two liver transplant immunosuppression regimens on renal function. Patients receiving the standard combination of prednisone and high-dose tacrolimus, a drug with known nephrotoxicity (Arm A) will be compared to patients receiving prednisone, low-dose tacrolimus and mycophenolate mofetil (MMF) (Arm B). MMF is an immunosuppression agent that has no associated nephrotoxicity. The primary end point of the study will be renal function as measured by glomerular filtration rate (GFR). Thirty pediatric liver transplant recipients will be randomized to these two arms in a 1:1 ratio (i.e. 15 patients in each group). Secondary end points will measure patient and graft outcome and incidence of immunosuppression-related complications, including: neurotoxicity, diabetes mellitus, growth retardation, vomiting, diarrhea, gastrointestinal hemorrhage, thrombocytopenia, anemia, leukopenia, acute or chronic liver graft rejection, posttransplant lymphoproliferative disease (PTLD), viral infections, fungal infections and bacterial infections.

Full description

The objective of this study is to compare the effects of two liver transplant immunosuppression regimens on renal function. Patients receiving the standard combination of prednisone and high-dose tacrolimus, a drug with known nephrotoxicity (Arm A) will be compared to patients receiving prednisone, low-dose tacrolimus and mycophenolate mofetil (MMF) (Arm B). MMF is an immunosuppression agent that has no associated nephrotoxicity. The primary end point of the study will be renal function as measured by glomerular filtration rate (GFR). Thirty pediatric liver transplant recipients will be randomized to these two arms in a 1:1 ratio (i.e. 15 patients in each group). Secondary end points will measure patient and graft outcome and incidence of immunosuppression-related complications, including: neurotoxicity, diabetes mellitus, growth retardation, vomiting, diarrhea, gastrointestinal hemorrhage, thrombocytopenia, anemia, leukopenia, acute or chronic liver graft rejection, posttransplant lymphoproliferative disease (PTLD), viral infections, fungal infections and bacterial infections.

Enrollment: 13 patients

Sex: All

Ages: Under 16 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• End-stage liver disease or acute fulminant hepatic failure recalcitrant to conventional medical or surgical therapy.
• Listed as candidate for pediatric liver transplantation listed with United Network for Organ Sharing (UNOS).
• Patients must be 18 years of age or younger.

Exclusion criteria

• History of autoimmune disease or primary sclerosing cholangitis.
• History of end-stage renal disease, dialysis treatment or acute renal failure (not including hepatorenal syndrome).
• Patients with pretransplant renal insufficiency as determined by a glomerular filtration rate (GFR) of <80 mL/min/1.73m2 (see below).
• Patients with renal agenesis or hypoplasia, polycystic kidney disease, or hydroureter seen on pretransplant renal ultrasound.
• Patients with malignancy or previous malignancy.
• Patients with active bacterial, viral, or fungal infections.
• Patients with a pretransplant diagnosis of diabetes mellitus.
• Patients with history of previous transplant or multi-organ recipients.
• Patients with serological evidence of HIV, HBSAg or HCV.
• Patients with hereditary syndrome that causes genetic deficiency of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) such as Lesch-Nyhan or Kelley-Seegmiller syndrome.
• Patients with history of phenylketonuria.
• Females that are pregnant or breastfeeding.
• Sexually active females who are not: a) post-menopausal, or b) surgically sterile, and c) using an acceptable method of contraception (oral contraceptive, implanted devices, injection, and barrier devices are acceptable; condoms used alone are not acceptable).
• Patients with alcohol abuse, substance abuse or smoking within the previous 6 months.
• Patients or caretakers of patients with psychogenic factors that preclude therapeutic compliance.
• Inability to reach participating hospital within 2 hours of notification.
• Any conditions or any circumstance that makes it unsafe to undergo a liver transplant.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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13 participants in 2 patient groups, including a placebo group

tacrolimus & corticosteroids

Placebo Comparator group

Description:

Standard post-transplant immunosuppression medications: tacrolimus and corticosteroids

Treatment:

Other: placebo medication

low-dose tacrolimus + steroids + MMF

Experimental group

Description:

Comparison arm: low-dose tacrolimus + steroids + MMF

Treatment:

Drug: mycophenolate mofetil