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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03500315
Other study ID # IRB00141138
Secondary ID U01AI134591
Status Completed
Phase N/A
First received
Last updated
Start date April 19, 2018
Est. completion date May 1, 2024

Study information

Verified date May 2024
Source Johns Hopkins University
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The primary objective of this study is to determine if an HIV-infected deceased kidney donor (HIVD+) transplant is safe with regards to major transplant-related and HIV-related complications.


Description:

This study will evaluate if receiving a kidney transplant from an HIV-infected deceased kidney donor is safe with regards to survival and major transplant-related and HIV-related complications compared to receiving a kidney from an HIV-uninfected deceased kidney donor (HIVD-). Those participants who have accepted an HIVD- organ will be randomized to be followed in the full study or followed in the nested observational group.


Recruitment information / eligibility

Status Completed
Enrollment 209
Est. completion date May 1, 2024
Est. primary completion date September 30, 2022
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Participant meets the standard criteria for kidney transplant at the local center. - Participant is able to understand and provide informed consent. - Participant meets with an independent advocate per the HIV Organ Policy Equity (HOPE) Act Safeguards. - Documented HIV infection (by any licensed assay, or documented history of detectable HIV-1 RNA). - No living donor available. - Participant is =18 years old. - Opportunistic complications: if prior history of an opportunistic infection, the participant has received appropriate therapy and has no evidence of active disease. - Cluster of Differentiation 4 (CD4)+ T-cell: =200/µL within 16 weeks of transplant. - HIV-1 is below 50 copies RNA/mL. Viral blips between 50-400 copies allowed as long as there are not consecutive measurements >200 copies/mL. - Participant is willing to comply with all medication related to their transplant and HIV management. - For participant with a history of aspergillus colonization or disease, no evidence of active disease. - The participant must have, or be willing to start seeing, a primary medical care provider with expertise in HIV management. - All participants participating in sexual activity that could lead to pregnancy must use an FDA approved method of birth control. - Participant is not suffering from significant wasting (e.g. body mass index <21) thought to be related to HIV disease. Exclusion Criteria: - Participant has a history of progressive multifocal leukoencephalopathy (PML) or primary central nervous system (CNS) lymphoma. - Participant is pregnant or breastfeeding. - Past or current medical problems or findings from medical history, physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks or may impact the quality or interpretation of the data obtained from the study.

Study Design


Related Conditions & MeSH terms


Intervention

Other:
HIV D+/R+
Kidney from an HIV-infected deceased donor

Locations

Country Name City State
United States Emory University Atlanta Georgia
United States Johns Hopkins University Baltimore Maryland
United States University of Maryland, Institute of Human Virology Baltimore Maryland
United States University of Alabama at Birmingham Birmingham Alabama
United States Massachusetts General Hospital Boston Massachusetts
United States University of Virginia Charlottesville Virginia
United States Northwestern University Chicago Illinois
United States Rush University Medical Center Chicago Illinois
United States University of Illinois at Chicago Chicago Illinois
United States University of Cincinnati Cincinnati Ohio
United States Methodist Health System Clinical Research Institute Dallas Texas
United States University of Texas Southwestern Medical Center Dallas Texas
United States Indiana University Indianapolis Indiana
United States University of Arkansas for Medical Sciences Little Rock Arkansas
United States University of California, Los Angeles Los Angeles California
United States Miami Transplant Institute Miami Florida
United States Yale University School of Medicine New Haven Connecticut
United States Ochsner Medical Center New Orleans Louisiana
United States Columbia University Medical Center New York New York
United States Icahn School of Medicine at Mount Sinai New York New York
United States New York University School of Medicine New York New York
United States Weill Cornell Medical College New York New York
United States Drexel University Philadelphia Pennsylvania
United States University of Pennsylvania Philadelphia Pennsylvania
United States UPMC-University of Pittsburgh Medical Center Pittsburgh Pennsylvania
United States University of California, San Diego San Diego California
United States University of California, San Francisco San Francisco California
United States MedStar Georgetown Transplant Institute Washington District of Columbia
United States Cleveland Clinic Florida Weston Florida

Sponsors (2)

Lead Sponsor Collaborator
Johns Hopkins University National Institute of Allergy and Infectious Diseases (NIAID)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Composite event, time to first death or graft failure or serious adverse event (SAE) or HIV breakthrough or opportunistic infection Time to first of any of the following events: death or graft failure or serious adverse event (SAE) or HIV breakthrough or opportunistic infection From date of transplant through administrative censorship at study completion, up to 4 years
Secondary Pre-transplant mortality Time to mortality while enrolled before transplant (survival framework) From date of enrollment to date of transplant or death of any cause, whichever comes first, assessed up to 4 years
Secondary Graft failure Time to mortality or re-transplant or return to maintenance dialysis (survival framework) From date of transplant through administrative censorship at study completion, up to 4 years
Secondary Rate of serious adverse events Count of post-transplant serious adverse events per person-year as assessed by Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.0 From date of transplant through graft failure or administrative censorship at study completion, up to year 4
Secondary 6-month acute rejection Proportion of recipients who experience acute rejection as measured by biopsy using Banff 2015 criteria: Borderline changes: 'Suspicious' for acute T-cell mediated rejection.This category is used when no intimal arteritis is present, but there are foci of mild tubulitis (t1, t2, or t3) with minor interstitial infiltration (i0 or i1) or interstitial infiltration (i2, i3) with mild (t1) tubulitis. Acute T-cell mediated rejection:Grade from IA defined as cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) to III defined as cases with 'transmural' arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3) From date of transplant to end of month 6
Secondary 1-year acute rejection Proportion of recipients who experience acute rejection as measured by biopsy using Banff 2015 criteria: Borderline changes: 'Suspicious' for acute T-cell mediated rejection.This category is used when no intimal arteritis is present, but there are foci of mild tubulitis (t1, t2, or t3) with minor interstitial infiltration (i0 or i1) or interstitial infiltration (i2, i3) with mild (t1) tubulitis. Acute T-cell mediated rejection:Grade from IA defined as cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) to III defined as cases with 'transmural' arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3) From date of transplant to end of year 1
Secondary Incidence of graft rejection Cumulative incidence of acute rejection (survival framework) as measured by biopsy using Banff 2015 criteria: Borderline changes: 'Suspicious' for acute T-cell mediated rejection.This category is used when no intimal arteritis is present, but there are foci of mild tubulitis (t1, t2, or t3) with minor interstitial infiltration (i0 or i1) or interstitial infiltration (i2, i3) with mild (t1) tubulitis. Acute T-cell mediated rejection:Grade from IA defined as cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) to III defined as cases with 'transmural' arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3) From date of transplant through administrative censorship, up to 4 years
Secondary Graft function - Proportion eGFR <60 mL/min/1.73 m2 Proportion of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2 3 months post-transplant
Secondary Graft function - Proportion eGFR <60 mL/min/1.73 m2 Proportion of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2 6 months post-transplant
Secondary Graft function - Proportion eGFR <60 mL/min/1.73 m2 Proportion of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2 9 months post-transplant
Secondary Graft function - Proportion eGFR <60 mL/min/1.73 m2 Proportion of transplant recipients with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2 1 year post-transplant
Secondary Graft function - Proportion eGFR <60 mL/min/1.73 m2 Proportion of participants with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2 2 years post-transplant
Secondary Graft function - Proportion eGFR <60 mL/min/1.73 m2 Proportion of participants with glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) < 60 mL/min/1.73 m2 3 years post-transplant
Secondary Graft function -mean eGFR Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 3 months post-transplant
Secondary Graft function-mean eGFR Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 6 months post-transplant
Secondary Graft function-mean eGFR Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 9 months post-transplant
Secondary Graft function-mean eGFR Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 1 year post-transplant
Secondary Graft function-mean eGFR Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2 years post-transplant
Secondary Graft function-mean eGFR Mean calculated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 3 years post-transplant
Secondary Graft function - slope eGFR The slope of glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) over time (longitudinal analysis) From date of transplant to end of follow-up, up to 4 years
Secondary Incidence of non-HIV renal disease Cumulative incidence of non HIV-related renal disease as measured by biopsy, e.g. focal segmental glomerulosclerosis 6 months post-transplant
Secondary Incidence of non-HIV renal disease Cumulative incidence of non HIV-related renal disease as measured by biopsy, e.g. focal segmental glomerulosclerosis 1 year post-transplant
Secondary Incidence of HIV-related renal disease Cumulative incidence of non HIV-related renal disease as measured by biopsy, e.g. HIV-associated nephropathy 6 months post-transplant
Secondary Incidence of HIV-related renal disease Cumulative incidence of non HIV-related renal disease as measured by biopsy, e.g. HIV-associated nephropathy 1 year post-transplant
Secondary Donor and recipient apolipoprotein L1 (APOL1) Proportion of transplant recipients with at least 1 apolipoprotein L1 (APOL1) risk variant in donor and recipient Baseline
Secondary HIV infection of renal allografts Proportion of recipients with HIV seen in laser capture microdissection of renal biopsy 6 months post-transplant
Secondary Trajectory of recipient plasma HIV RNA over time Analysis of repeated measures of plasma HIV RNA (longitudinal model) From date of transplant through end of follow-up, up to 4 years
Secondary Trajectory of recipient Cluster of Differentiation (CD4) count over time Analysis of repeated measures of Cluster of Differentiation 4 (CD4) count (longitudinal model) From date of transplant through end of follow up, up to 4 years
Secondary Incidence of antiretroviral resistance Measured by local sites' Clinical Laboratory Improvement Amendments (CLIA) certified lab with episode of HIV breakthrough defined as 2 consecutive plasma HIV viral loads >200 copies/mL or one HIV viral load >1000 copies/mL after a period of virologic control post-transplant From date of transplant through end of follow-up, up to 4 years
Secondary Incidence of X4 tropic virus Measured by local sites' Clinical Laboratory Improvement Amendments (CLIA) certified lab with episode of HIV breakthrough defined as 2 consecutive plasma HIV viral loads >200 copies/mL or one HIV viral load >1000 copies/mL after a period of virologic control post-transplant From date of transplant through end of follow-up, up to 4 years
Secondary Incidence of opportunistic infection Cumulative incidence of opportunistic infections From date of transplant through end of follow-up, up to 4 years
Secondary Incidence of surgical complications Number of surgical complications within 1 year of transplant, e.g. delayed closure, wound dehiscence From date of transplant through year 1
Secondary Incidence of vascular complications Number of vascular complications within 1 year of transplant From date of transplant through year 1
Secondary Incidence of viral-related malignancies Number of malignancies as determined by local pathology From date of transplant through end of follow-up, up to 4 years
Secondary Incidence of the formation of de novo donor-specific human leukocyte antigen(HLA) antibodies Proportion of participants with a de novo donor-specific HLA antibody as measured and reported by local sites' lab From date of transplant through end of year 1
Secondary Composite event, time to first Time to first of any of these events: all-cause-mortality or graft failure or renal allograft rejection or HIV breakthrough or HIV virologic failure or AIDS defining illness From date of transplant through end of follow-up, up to 4 years
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