Kidney Transplantation Clinical Trial
Official title:
Astagraf XL® to Understand the Impact of Immunosuppression on De Novo DSA Development and Chronic Immune Activation in Kidney Transplantation
This study compared the incidence of a two-part composite endpoint consisting of de novo donor specific antibody (DSA) formation or a designation of immune activation (IA) on peripheral blood molecular profiling in participants maintained on twice daily, immediate-release tacrolimus versus those maintained on Astagraf XL in the first year post-transplant.
This was an exploratory, two year (shortened to 1 year due to a stopping rule necessitated by
the adaptive design), prospective, randomized, multi-center, open-label trial examining
long-term kidney transplant outcomes through the use of an adaptive design and a two-part,
composite surrogate endpoint. Specifically, it was designed to compare the effects of twice
daily, immediate-release tacrolimus and once daily Astagraf XL on DSA formation and the
development of a peripheral blood molecular profile indicating the presence of IA in de novo
kidney transplant recipients during the first year following transplantation. For the
purposes of this study, IA was defined as a positive molecular signature using a molecular
assay in all participants.
Participants were screened prior to surgery and randomized 1:1 to receive immediate-release
tacrolimus, administered twice daily, or Astagraf XL, as a component of a standard
immunosuppression maintenance regimen also consisting of corticosteroids (if given per
institutional protocol) and mycophenolate mofetil (MMF) (or Myfortic® equivalent).
Investigators were encouraged to start participants on the randomized study treatment
(immediate release tacrolimus or Astagraf XL) within 48 hours of transplantation
(pre-transplant administration of study treatment was not allowed). However, if medically
indicated per the treating physician's discretion, initiation of study treatment was delayed
for up to seven days post-transplant.
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