Effects of Donor and Recipient Genetic Expression on Heart, Lung, Liver, or Kidney Transplant Survival
Study Details
Study Description
Brief Summary
Activity of genes in donor tissues that are involved in inflammation are thought to be involved with early organ dysfunction, increased immune responses in transplant recipients, and organ rejection. The purpose of this study is to determine the relationship between genetic expression in donor and recipient tissue with transplant survival. Participants in this study will have received heart, lung, liver, or kidney transplants.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Inflammation and injuries to transplanted organs during the immediate post-operative period may be linked to early organ dysfunction and higher rates of transplant rejection in the recipient. Currently, mRNA expression of proinflammatory genes in donor tissues is thought to be a risk factor for early organ transplant dysfunction, increased expression of the recipients cell-mediated immunity genes, and organ rejection. The purpose of this study is to test the association between proinflammatory mRNA expression in donor samples and subsequent development of early organ dysfunction in kidney, lung, and liver transplant recipients. This study will also test the effects of proinflammatory mediators expressed in the transplanted organ pre- and post-reperfusion on organ rejection and genes expressed in cell mediated immune responses. This will be achieved by identifying the proinflammatory immune responses and their mechanisms.
This study will consist of up to 11 study visits over a period of 2 years. The baseline visit will occur 24 hours prior to organ transplantation. Follow-up visits will occur daily for Days 1 to 3 (for lung transplant recipients only) and on Day 7, Week 6, and Months 3, 6, 9, 12, 18, and 24 post-transplant. At the baseline visit, a physical exam, medical history, demographics, vital signs measurements, blood collection, and collection of donor tissue sample will occur. For most or all other study visits, medication and adverse events tracking and blood collection will occur. Depending on the transplant type, participants will undergo the following procedures:
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Heart: Participants will undergo a heart biopsy that is part of standard clinical care following a heart transplant. An echocardiogram and an electrocardiogram will occur at most visits.
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Kidney: Renal biopsies will be performed 1 hour after reperfusion at the time of surgery. Urine collection will occur at most visits.
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Liver: Liver biopsies will be performed at the time of procurement and within 1 hour of reperfusion.
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Lung: Participants will undergo bronchoalveolar lavage that is part of standard clinical care following a lung transplant. A chest x-ray, an arterial blood gas test, a pulmonary function test, and 6-minute walking test will occur at some visits.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Kidney transplants patients from 5 specific sites |
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| Liver transplants patients from 5 specific sites |
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| Heart transplants patients from 5 specific sites |
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| Lung transplants patients from 5 specific sites |
Outcome Measures
Primary Outcome Measures
- Association between proinflammatory mRNA expression in donor samples and subsequent development of early organ dysfunction in the immediate period following transplantation [Within first 7 days after transplant]
- Association of mRNA expression of proinflammatory mediatros in the transplanted organ in the immediate pre and post-reperfusion period with subsequent incidence of acute rejection and expression of genes involved in cell mediated immunity [12 months after transplant]
Eligibility Criteria
Criteria
Inclusion Criteria for all participants:
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Received single lung, heart, kidney, or liver transplant
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Specimens of donor tissues have been collected
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Parent or guardian willing to provide informed consent, if applicable
Inclusion Criteria for Kidney or Liver Transplant Participants:
- 70 years old or younger
Inclusion Criteria for Heart or Lung Transplant Participants:
- Between 16 and 70 years old
Exclusion Criteria for All Participants:
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Previous solid organ transplant
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Need for combined organ transplant
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HIV or hepatitis C virus infection
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Recipient of an organ from a hepatitis C virus-infected donor
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Clinical evidence of systemic bacterial infection in the recipient at the time of transplantation
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Living donor transplant recipient of either a kidney, liver, or lung
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Northwestern Memorial Hospital (kidney and liver) | Chicago | Illinois | United States | 60611 |
| 2 | Cornell University Medical College (kidney) | Ithaca | New York | United States | 14850 |
| 3 | Columbia University (lung and liver) | New York | New York | United States | 10032 |
| 4 | University of Pennsylvania (heart, kidney, liver, lung) | Philadelphia | Pennsylvania | United States | 19104 |
| 5 | University of Wisconsin (heart and lung) | Madison | Wisconsin | United States | 53706 |
Sponsors and Collaborators
- National Institute of Allergy and Infectious Diseases (NIAID)
- National Heart, Lung, and Blood Institute (NHLBI)
Investigators
- Principal Investigator: Abraham Shaked, MD, PhD, University of Pennsylvania Medical Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Fox-Marsh A, Harrison LC. Emerging evidence that molecules expressed by mammalian tissue grafts are recognized by the innate immune system. J Leukoc Biol. 2002 Mar;71(3):401-9. Review.
- Isobe M, Suzuki J. New approaches to the management of acute and chronic cardiac allograft rejection. Jpn Circ J. 1998 May;62(5):315-27. Review.
- Jiang S, Lechler RI. CD4+CD25+ regulatory T-cell therapy for allergy, autoimmune disease and transplant rejection. Inflamm Allergy Drug Targets. 2006 Dec;5(4):239-42. Review.
- Kaplan B, Srinivas TR, Meier-Kriesche HU. Factors associated with long-term renal allograft survival. Ther Drug Monit. 2002 Feb;24(1):36-9. Review.
- Lande JD, Patil J, Li N, Berryman TR, King RA, Hertz MI. Novel insights into lung transplant rejection by microarray analysis. Proc Am Thorac Soc. 2007 Jan;4(1):44-51. Review.
- Reding R, Gras J, Truong DQ, Wieërs G, Latinne D. The immunological monitoring of alloreactive responses in liver transplant recipients: a review. Liver Transpl. 2006 Mar;12(3):373-83. Review.
- Zheng XX, Sánchez-Fueyo A, Sho M, Domenig C, Sayegh MH, Strom TB. Favorably tipping the balance between cytopathic and regulatory T cells to create transplantation tolerance. Immunity. 2003 Oct;19(4):503-14.
- DAIT CTOT-03