Safety and Efficacy of Basiliximab, Delayed Dose Tacrolimus Plus ECMPA (Enteric Coated Mycophenolic Acid) Following Liver Transplantation

Phase 4

Completed

Conditions: Liver Transplantation

Interventions: Drug: Basiliximab
Drug: Tacrolimus
Drug: Mycophenolic Acid

Registration Number: NCT02123108

Lead Sponsor: University of California, Los Angeles

Brief Summary: This is an investigator initiated study at the University of California, Los Angeles (UCLA) funded by Novartis looking at using a combination of immunosuppressive drugs in liver transplant patients that are at risk of developing kidney problems. Kidney problems following liver transplants is the most problematic issue facing liver transplant patients today.

This study will generate information in this area of high unmet medical need utilizing basiliximab and Myfortic and using a reduced dose of tacrolimus, one of the current standard of care medications, after kidney function has normalized.

Detailed Description: Since basiliximab works on the same receptor system as tacrolimus and has not been shown to cause significant adverse effects, such as nephrotoxicity or the cytokine release syndrome, the investigators are proposing induction therapy with basiliximab in liver transplant patients with concomitant preoperative renal dysfunction. This will combat acute rejection and allow the delay of tacrolimus therapy until post-operative day #7. The delay in tacrolimus therapy should allow renal function to improve and reduce the chance of continued renal dysfunction. Also, the addition of basiliximab to the immunosuppressive regimen should allow for a reduction in tacrolimus dose (normal tacrolimus concentrations at UCLA are 7-10ng/mL. Our goal will be 3-5ng/mL) in the immediate post-transplant period thereby reducing the chance of acute and long-term efficacy-limiting adverse effects associated with the tacrolimus while maintaining adequate immunosuppression to reduce acute rejection episodes. This would be the most convincing prospective randomized study utilizing basiliximab as a renal sparing agent in liver transplantation.

Objectives Primary objectives

• To evaluate renal recovery/ function following OLT in patients undergoing orthotopic liver transplant at 6 and 12 months post-transplant.

Secondary objectives (comparing the two treatment arms)

* To determine the tolerability and adverse event profile during the first year post-transplant.

* To determine incidence and severity acute rejection episodes

* To determine the incidence of death and/or graft failure within the first year post-transplant

Study design The study is a single center prospective randomized trial wherein the investigators will have two groups. Patients will be screened and eligible patients will be enrolled pre-transplant. Patients will then be randomized at time of transplant to either the control or treatment arm. Post transplant laboratory data (chemistry, tacrolimus level and liver function tests) will be collected on a daily basis. For the duration of the patients' hospital stay (average 2-3 weeks). This will provide the early data set for early post operative results. Patients will subsequently be followed on a weekly outpatient basis upon discharge as per protocol. During these visits, laboratory data (chemistry, tacrolimus level and liver function tests) are also collected and will provide the continued flow of data for our follow up analysis. Any evidence of rejection will prompt treatment with rescue therapy and if necessary disenrollment from the study.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 59

Inclusion Criteria

Patients eligible for inclusion in this study have to fulfill all of the following criteria:

>18 years old
Undergoing first or second OLT
MELD (model for end-stage liver disease) score >25
Serum creatinine > 1.5 or ongoing hemodialysis for less than 4 weeks at the time of transplant
Able and agreeable to conform to requirements of the study
Patients or proxy must give written informed consent before any assessment is performed.

Exclusion Criteria

<18 years old
Serum creatinine <1.5
MELD Score < 25
Ongoing hemodialysis for 4 or more weeks (those patients become eligible for renal transplants at that point per UCLA practice).
Receiving OKT3 (Muromonab-CD3), ATG (Antithymocyte Globulin), or IVIG (Intravenous Immunoglobulin Therapy) therapy around time of transplant
Participating in another clinical research study involving the evaluation of another investigational drug or device
Prior documented allergy to any of the study medications
Active Fungal infection

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Basiliximab	Tacrolimus	Tacrolimus with Basiliximab induction
Basiliximab	Mycophenolic Acid	Tacrolimus with Basiliximab induction
Tacrolimus Group	Mycophenolic Acid	Tacrolimus (without basiliximab induction); standard of care group
Tacrolimus Group	Tacrolimus	Tacrolimus (without basiliximab induction); standard of care group
Basiliximab	Basiliximab	Tacrolimus with Basiliximab induction

Primary Outcome Measures

Name	Time	Method
Renal Recovery/ Function	12 months post-transplant	Number of participants who experienced dialysis independence or improvement based upon kidney function labs as a measure of renal recovery/ function following OLT in patients after undergoing orthotopic liver transplant

Secondary Outcome Measures