Noninvasive Methods to Monitor Graft Survival in Heart Transplant Patients
Study Details
Study Description
Brief Summary
Injury of transplant tissue by a transplant recipient's immune system continues to be the leading cause of graft rejection and recipient death. The purpose of this study is to identify a single test or a combination of noninvasive tests currently used for heart transplant monitoring that correlate to long-term graft survival.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
A major cause of heart transplant failure is the blockage of blood flow from lesions caused by ongoing injury and repair of the graft by the host's immune system. However, the role of T cells, antibodies, and other parts of the recipient's immune system are not well understood in transplant injury. Currently, there are no effective, noninvasive ways to detect or predict how an individual's immune system will react to a transplant. The purpose of this study is to correlate current noninvasive monitoring tests with long-term graft survival and function, and determine which tests are the most accurate predictors of this survival.
Participants in this study must currently be on the waiting list for a heart transplant and have a donor heart available to them. This study will consist of six study visits over 12 months. The baseline visit will occur on the day of transplantation. Follow-up visits will occur at Week 6 and Months 3, 6, 9, and 12 post-transplant. At each visit, a physical exam, medication tracking, assessment of graft survival, and blood and urine collection will occur. At the Week 6 and Month 12 visits, intravascular ultrasound and echocardiograms will occur. At the Week 6, Month 6, and Month 12 visits, endomyocardial biopsies will also occur. No immunosuppressive therapy will be provided by the study.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Heart Transplant Recipients People who will have a heart transplant |
Procedure: Heart transplant
People in this study will have a heart transplant and be monitored for signs of rejection
|
Outcome Measures
Primary Outcome Measures
- Composite Measure of Transplant Health [12 months after enrollment in study]
A composite of incidence of the following: Death, Re-transplantation or re-listed for transplantation, Biopsy proven acute rejection (BPAR) of > 2R, Episode of rejection associated with hemodynamic compromise, Coronary artery vasculopathy defined by a change in MIT of >0.5 mm between study entry and 12 months.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age greater than 10 and a body mass of 30 kg (66 lbs) or more
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On waiting list for a heart transplant for whom a donor heart available
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Willing to comply with study protocol
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Willing to use acceptable forms of contraception
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Parent or guardian willing to provide consent, if applicable
Exclusion Criteria:
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Receiving multiple organ transplants
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Previously received organ transplants
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Other comorbidities that, in the opinion of the site investigator, would interfere with the study
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Currently taking immunosuppression for nontransplant reasons
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Participation in an interventional clinical trial
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Pregnancy or breastfeeding
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of California | San Francisco | California | United States | 94143 |
| 2 | Northwestern University Medical School | Chicago | Illinois | United States | 60611 |
| 3 | Loyola University School of Medicine | Maywood | Illinois | United States | 60153 |
| 4 | University of Maryland | Baltimore | Maryland | United States | 21201 |
| 5 | Massachusetts General Hospital | Boston | Massachusetts | United States | 02114 |
| 6 | Brigham and Women's Hospital | Boston | Massachusetts | United States | 02115 |
| 7 | Beth Israel Medical Center | Newark | New Jersey | United States | 07112 |
| 8 | Mount Sinai School of Medicine | New York | New York | United States | 10029 |
| 9 | The Cleveland Clinic Foundation | Cleveland | Ohio | United States | 44122 |
| 10 | Medical City Dallas Hospital | Dallas | Texas | United States | 75230 |
| 11 | University of Utah, LDS Hospital | Salt Lake City | Utah | United States | 84148 |
| 12 | University of Utah, VACM.LDS | Salt Lake City | Utah | United States | 84148 |
Sponsors and Collaborators
- National Institute of Allergy and Infectious Diseases (NIAID)
- National Heart, Lung, and Blood Institute (NHLBI)
- Clinical Trials in Organ Transplantation
Investigators
- Principal Investigator: Peter S. Heeger, MD, Icahn School of Medicine at Mount Sinai
- Principal Investigator: Mohamed H. Sayegh, MD, Brigham and Women's Hospital
- Study Chair: Randall Starling, MD, The Cleveland Clinic
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- Click here for the Clinical Trials in Organ Transplantation [CTOT] public Web site
- National Institute of Allergy and Infectious Diseases (NIAID)
Publications
- 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.
- Starling RC, Pham M, Valantine H, Miller L, Eisen H, Rodriguez ER, Taylor DO, Yamani MH, Kobashigawa J, McCurry K, Marboe C, Mehra MR, Zuckerman A, Deng MC; Working Group on Molecular Testing in Cardiac Transplantation. Molecular testing in the management of cardiac transplant recipients: initial clinical experience. J Heart Lung Transplant. 2006 Dec;25(12):1389-95. Review. Erratum in: J Heart Lung Transplant. 2007 Feb;26(2):204.
- 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-05