Chronic Allograft Dysfunction in Renal Transplantation Clinical Trial
Official title:
Impact and Efficacy of Everolimus Rescue Immunosuppression in the Treatment of Chronic Allograft Dysfunction in Renal Transplant Recipients
Despite the remarkable improvement in short-term patient and graft survival among the
recipients of kidney transplants, the progressive renal dysfunction (chronic allograft
dysfunction) accompanied by chronic interstitial fibrosis, tubular atrophy, vascular
occlusive changes and glomerulosclerosis remains the chief cause of graft loss. As a result
of this damage from immunologic and non-immunologic injury, the long-term survival of kidney
transplants has changed little during the past decade. And, among the non-immunologic
factors, calcineurin inhibitor nephrotoxicity has been shown to be the most common factor
leading to long-term graft damage and progression to graft failure. This is further
supported by the previous finding that long-term use of calcineurin inhibitor-based therapy
leads to deterioration in kidney function, even in recipients of non-renal organ
transplants.
The growing interest in calcineurin inhibitor minimisation protocols to optimize renal
transplant outcome offers a new therapeutic options in the management of patients with
chronic allograft dysfunction. Recently, mammalian target-of-rapamycin inhibitors (mTOR
inhibitors) including everolimus has been shown to achieve an improvement of long-term
function through an early modulation of immunosuppressive regimen. In this aspect,
percutaneous renal graft biopsy represents an important diagnostic tool to allow
visualization of the lesions of chronic allograft dysfunction and therefore the ability to
delineate the potential improvement after introduction of everolimus. Histologic and
morphometric findings from a protocol-mandated biopsies obtained from renal transplant
recipients who are suffering from chronic allograft dysfunction and treated with everolimus
are needed to provide a clinical blueprint for the drug's efficacy, if confirmed.
The objective of the present study is to evaluate the a priori hypothesis that calcineurin inhibitor and rescue immunosuppression with everolimus-based therapy would attenuate the renal parenchymal injury associated with long-term use of calcineurin inhibitors in renal transplant recipients with declining kidney function. Another objective of this study is to elucidate the efficacy of our approach to arrest the progression of allograft dysfunction by means of protocol renal allograft biopsy. ;
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment