Kidney Transplant Clinical Trial
Official title:
A Multicenter, Randomized, Parallel-group, Trial to Reduce Toxicity of Calcineurininhibitor-therapy in Steroid-free Longterm Immunosuppression in Pediatric and Adolescent Kidney Transplant Recipients
The purpose of this study is to determine if a safe reduction of cyclosporine A in pediatric and adolescent patients with stable renal graft function, reduces signs of calcineurin-inhibitor toxicity.
Chronic transplant nephropathy is one of the major causes of graft loss after renal
transplantation. Toxicity of calcineurin-inhibitors is suspected to be one cause for loss of
graft function. Therefore reduction of cyclosporine A dosing can result in longer graft
survival and better graft function in patients after renal-transplantation. However,
reduction of immunosuppression can result in acute rejection episodes, although it is less
likely in patients with stable graft function 12 months or longer after successful renal
transplantation.
Therefore the aim of this randomized, controlled study in pediatric and adolescent renal
transplant recipients, is to compare the impact of reduced cyclosporine A-dosing to standard
CSA-dosing on renal graft function. Therapy monitoring in both groups will be performed by
obtaining CSA blood levels two hours after intake, as they provide an individual insight in
pharmacokinetics in comparison to conventional trough level (C0)-measurements.
Secondary objectives to evaluate are
1. the evaluation of the health-related Quality of life and psychosocial burden in the two
treatment arms.
2. measurement of the NFAT-regulated gene expression (nuclear factor of activated t-cells)
of intracellular cytokines [Interleukin-2, TNF-alpha, Interferon-gamma and GMCSF) by
quantitative PCR as measurement of CSA activity.
3. To obtain new insights by screening for metabolites conjunct with clinic features of
nephrotoxicity or graft rejections a metabolomic screening and a targeted analysis
(trimethylamine-N-oxide, neopterin and kynurenine/tryptophan ratio) will be performed.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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