Calcineurin Inhibitor in NEuRoloGically Deceased Donors to Decrease Kidney delaYed Graft Function (CINERGY)

Brain Death Clinical Trial

— CINERGY  

Official title:

Calcineurin Inhibitor in NEuRoloGically Deceased Donors to Decrease Kidney delaYed Graft Function (CINERGY)-Pilot Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05148715
• Other study ID #: MP-31-2020-3348
• Status: Recruiting
• Phase: Phase 2
• Start date: July 11, 2022
• Est. completion date: January 2026

Study information

• Verified date: March 2024
• Source: Université de Sherbrooke
• Contact: Ruth Breau
• Phone: 9055259140
• Email: breaur[@]mcmaster.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The investigators hypothesize that preconditioning neurologically deceased organ donors with the calcineurin inhibitor tacrolimus will improve short and long-term transplant survival without causing harm. Organ donors will be randomized to receive either 0.02 mg/kg ideal body weight (IBW) of tacrolimus single infusion or placebo before organ recovery. All corresponding recipients are enrolled and data is collected up to 7 days post-transplant to determine graft function and at 1 year to collect outcomes of vital status, re-transplantation and dialysis. The CINERGY Pilot Trial assesses feasibility for the main trial.

Description:

Background: Organ donation saves lives, and improves quality of life for thousands of people. But organ donation falls short of expectations for some patients who suffer early graft loss. During organ donation surgery, the supply of blood with oxygen and nutrients is suspended. When restored during transplant surgery, a cascade of inflammation perturbs the newly transplanted organ -causing ischemia-reperfusion injury. When severe, it can hinder transplant function in the early post-operative period, lead to profound critical illness, increase the risks of transplant rejection and chronic disease, and reduce the transplant lifespan. Administration of tacrolimus, a calcineurin inhibitor, to neurologically deceased donors may reduce ischemia-reperfusion injury in transplant recipients. Objectives: The CINERGY Pilot Trial will test the feasibility of comparing tacrolimus to placebo for the prevention of delayed graft function in kidney recipients and establish the foundation for a large, multi-centre randomized controlled trial (RCT). Methods: 90 neurologically deceased kidney donors will be randomized to either tacrolimus (0.02 mg/kg) or the corresponding placebo 4-8 hours before organ recovery. To be included in the CINERGY Pilot RCT, donors will need to meet inclusion criteria. All corresponding recipients are enrolled and their data is collected in the first 7 days and at 12 months after transplantation. Outcomes: Feasibility: Donor accrual rate and consent rate of organ recipients. Safety: acute kidney injury, hyperkalemia and anaphylaxis in donors and recipients. Clinical: graft function within 7 days in all recipients, vital status, re-transplantation and need for dialysis at 12 months. Relevance: This pilot study will inform the feasibility and design of a larger trial. Moreover, the CINERGY Pilot RCT will pave the way for future trials linking organ donation and transplantation across Canada.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 414
• Est. completion date: January 2026
• Est. primary completion date: January 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Neurologically deceased donors who meet the inclusion and exclusion criteria will be eligible for participating in this study along with the correlating organ recipients who meet inclusion criteria.

Donor Inclusion Criteria:

• =18 years of age;
• Neurologically deceased;
• Consent for deceased organ donation;
• All organ recipients have been identified;
• = 1 kidney allocated to a recipient.

Donor Exclusion Criteria:

• Known hypersensitivity to tacrolimus or polyoxyl 60 hydrogenated castor oil;
• One or more organs allocated to a non-participating transplant program;
• Unlikely access to study drug (e.g., due to supply issues, or pharmacist availability);
• One or more organ recipients has not agreed to receive an organ from a donor participating in the study;
• One or more organs are allocated to a recipient under the age of 18;
• A transplant physician has judged that donor tacrolimus will be unsuitable for an intended recipient. Recipient Inclusion Criteria
• Organ/Transplant graft originated from a donor enrolled in this study. No exclusion criteria.

Related Conditions & MeSH terms

• Brain Death
• Delayed Graft Function
• Ischemic Reperfusion Injury
• Organ Transplant Failure or Rejection
• Reperfusion Injury

Intervention

Drug:
• Tacrolimus
Single dose intravenous tacrolimus over 4 hour infusion at a dose of 0.02 mg/kg ideal body weight diluted with 0.9% sodium chloride starting 4-8 hours before scheduled organ recovery.
• Placebo
Single dose of intravenous 0.9% sodium chloride over 4 hour infusion, starting 4-8 hours before scheduled organ recovery.

Locations

Country	Name	City	State
Canada	Centre Hospitalier Universitaire de Montréal	Montréal	Quebec
Canada	Centre universitaire de santé McGill (CUSM)	Montréal	Quebec
Canada	Hôpital Maisonneuve-Rosemont	Montréal	Quebec
Canada	L'Institut de Cardiologie de Montréal	Montréal	Quebec
Canada	Centre Hospitalier Universitaire de Québec- Université Laval	Quebec city	Quebec
Canada	Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ)	Québec City	Quebec
Canada	Centre de recherche CHUS	Sherbrooke	Quebec

Sponsors (2)

Lead Sponsor	Collaborator
Université de Sherbrooke	McMaster University

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Organ donor accrual rates	One primary objective of this pilot study is to determine if a national multi-centre placebo randomized controlled trial (RCT) will be feasible with respect to: organ donor accrual.	6 to 12 months after the beginning of the trial
Primary	Recipient consent rate	Another primary objective of this pilot study is to determine if a national multi-centre placebo controlled RCT will be feasible with respect to the consent rates of organ recipients. Recipient consent rates will be assessed during analysis, analyzing the rate and reasons for non-enrolment.	6 to 12 months after the beginning of the trial
Secondary	Correlation between two methods for obtaining survival status	We will compare 2 methods (Hospital records, Canadian Institute for Health Information) for obtaining recipient survival at 12 months post-transplant.	12 months post transplant
Secondary	Unexpected adverse events	In donors and recipients, unexpected adverse events as identified by clinical staff will be reported and analyzed.	Within 7 days post transplant
Secondary	Percentage of donors with acute kidney injury (AKI)	AKI defined as defined as Kidney disease: Improving global outcome (KDIGO) stage II (or more): serum creatinine = 2.0 times baseline OR a urine output <0.5mL/kg/h for =12 hours	Within 4 hours after the end of the study drug infusion
Secondary	Percentage of donors with hyperkalemia	Hyperkalemia defined as a potassium level > 5 mmol/L	Within 4 hours after the end of the study drug infusion
Secondary	Percentage of donors hypertension during tacrolimus infusion	Hypertension (systolic blood pressure = 160 mmHg or mean arterial pressure = 90 mmHg for > 15 minutes)	Within 4 hours after the initiation of study drug infusion
Secondary	Percentage of donors with cardiac arrhythmia associated with tacrolimus infusion	Cardiac arrhythmias defined as new onset of atrial fibrillation or flutter, ventricular tachycardia or fibrillation	Within 4 hours after the initiation of study drug infusion
Secondary	Percentage of donors with anaphylaxis	Anaphylaxis defined as per The American Academy of Allergy, Asthma and Immunology	Within 4 hours after the initiation of study drug infusion
Secondary	Percentage of recipients with acute kidney injury	AKI defined as defined as KDIGO stage II or more: serum creatinine = 2.0 times baseline OR a urine output <0.5mL/kg/h for =12 hours	Within 7 days post transplant
Secondary	Percentage of recipients with hyperkalemia	Hyperkalemia defined as a potassium level > 5 mmol/L	Within 7 days post transplant
Secondary	Percentage of recipients with anaphylaxis	Anaphylaxis defined as per The American Academy of Allergy, Asthma and Immunology	Within 7 days post transplant
Secondary	Recipient serum tacrolimus levels	Clinical research staff will abstract routine serum tacrolimus levels (when measured) from hospital records over the first 7 days, along with local thresholds for toxic level.	Within 7 days post transplant
Secondary	Percentage of liver recipients with early graft function	At least = 1 of the following criteria: Bilirubin = 10 mg/dL , International normalized ratio (INR) = 1.6 AST or ALT level > 2000 IU/	Within 7 days post transplant
Secondary	Graft survival	Need to be re-transplanted or to be on the re-transplant list.	12 months post transplant
Secondary	Recipient survival	Recipient death	12 months post transplant
Secondary	Recipients requiring dialysis	Recipient requirement for dialysis at 12 months	12 months post transplant
Secondary	Percentage of lungs recipients with severe primary graft dysfunction	PaO2/FiO2 ratio <200 and diffuse infiltration/pulmonary edema on chest radiograph	Within 3 days post transplant
Secondary	Percentage of kidney recipients with delayed graft function	Requirement of = 1 hemodialysis session	Within 7 days post transplant
Secondary	Percentage of heart recipients with severe primary graft dysfunction	Dependence on mechanical support	Within 1 days post transplant
Secondary	Percentage of pancreas recipients with delayed graft function	Requirement of =1 exogenous insulin at hospital discharge	At hospital discharge, an average of 7 days