De Novo Everolimus Versus Tacrolimus in Combination With Mofetil Mycophenolate and Low Dose Corticosteroids to Reduce Tacrolimus Induced Nephrotoxicity in Liver Transplantation: a Prospective, Multicentric, Randomised Study
- Conditions
- Liver Transplantation
- Interventions
- Registration Number
- NCT02909335
- Lead Sponsor
- Rennes University Hospital
- Brief Summary
Tacrolimus is a calcineurin inhibitor. This is the immunosuppression of reference for patients undergoing a first liver transplant. This treatment can prevent graft rejection, but can cause side effects including kidney failure (in 25% after the first year).
Everolimus is an immunosuppressive that effectively prevents acute rejection in heart and kidney transplant recipients. It preserves renal function when it is started soon after the transplant, i.e. before a severe dysfunction is installed.
- Detailed Description
In the liver transplant, early interruption of calcineurin inhibitors with a quick relay everolimus monotherapy preserves renal function and is associated with a lower acute rejection rate.
We wish to assess whether the introduction of a de novo immunosuppression everolimus under protection of basiliximab induction, mycophenolate mofetil and then low doses of corticosteroids, reduces the nephrotoxicity of immunosuppressive therapy in liver transplant patients, compared to a standard protocol with tacrolimus associated with mycophenolate mofetil and low dose corticosteroids.
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Adults (≥18 years), male or female,
- Patients due to receive a first liver transplant with a full or reduced graft taken from a donor brain-dead beating heart or a related living donor,
- Patients having given a free and informed written consent .
Post-transplantation Inclusion criteria: Patients meeting the following criteria will be included:
- Receiving basiliximab (Simulect)
- Whose immunosuppression regimen from day 5 could immediately consist of either tacrolimus or everolimus, in combination with mycophenolate mofetil and low dose corticosteroids
- With hepatic artery permeable to echo Doppler 4 days after transplant.
- History of immunosuppressive therapy,
- Known hypersensitivity to the treatments or macrolides,
- HIV infection
- Autoimmune hepatitis,
- Primary sclerosing cholangitis,
- Programming or realization of a combined transplant,
- Pregnancy or lack of effective contraception,
- Breastfeeding.
- Incompatibility with the donor,
- Thrombosis of the hepatic artery between D0 and D4,
- Non-primary graft function leading to a re-registration on the waiting list.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Tacrolimus group Prednisolone, Prednisone or Methylprednisolone Tacrolimus + mycophenolate mofetil + corticosteroids Everolimus group Prednisolone, Prednisone or Methylprednisolone Everolimus + mycophenolate mofetil + corticosteroids Tacrolimus group Everolimus Tacrolimus + mycophenolate mofetil + corticosteroids Tacrolimus group Mycophenolate mofetil Tacrolimus + mycophenolate mofetil + corticosteroids Everolimus group Tacrolimus Everolimus + mycophenolate mofetil + corticosteroids Everolimus group Mycophenolate mofetil Everolimus + mycophenolate mofetil + corticosteroids
- Primary Outcome Measures
Name Time Method Occurrence of graft loss Between the baseline and the end of the treatment (week 48) (censored criterion Graft loss , whatever the cause, or thrombosis of the hepatic artery are recorded between baseline and the end of S48 (censored criterion).
Worsening of renal function Between the initiation of treatment (Day 5) and the end (week 48) (censored criterion) The main objective of the study is to evaluate, in liver transplanted patients, the benefit in terms of prevention of renal failure, a regimen that includes a de novo introduction of everolimus instead of tacrolimus, in combination with mycophenolate mofetil and low doses of corticosteroids, to the extent that this benefit is not accompanied by an increased risk of graft loss or hepatic artery thrombosis.
Insofar as the objective of the study is to assess a risk / benefit ratio, the study has two main criteria.
Worsening renal function is validated before the prolonged decline (found on at least 3 assays carried out at least 3 months apart) over 30% of the creatinine clearance compared to the value at baseline . The date of the first evidence of this worsening of renal function is the date used to calculate the distribution of censored criterion.
- Secondary Outcome Measures
Name Time Method Plasma creatinine At the end of the treatment (week 48) Glomerular filtration rate At the end of the treatment (week 48) Glomerular filtration rate calculated following Modification of Diet in Renal Disease (MDRD) formula
Hypertension control Between the baseline and the end of the treatment (week 48) (censored criterion) Occurrence of hypertension requiring the introduction of antihypertensive therapy (censored criterion)
Occurence of convulsions Between the baseline and the end of the treatment (week 48) (censored criterion) Occurrence of convulsion episodes from baseline to the end of W48 (censored criterion)
Hypertriglyceridemia Between the baseline and the end of the treatment (week 48) (censored criterion) Occurrence of hypertriglyceridemia requiring the introduction of lipid-lowering therapy (censored criterion)
Number of patients with incident diabetes Between the baseline and the end of the treatment (week 48) (censored criterion) Patients presenting development of diabetes requiring the introduction of a hypoglycaemic therapy (censored criterion)
Number of patients with infection At the end of the treatment (week 48) Rate of patients who had at least one infection between baseline and the end of S48 requiring the use of an etiological treatment
Occurrence of mental trouble Between the baseline and the end of the treatment (week 48) (censored criterion) Occurrence of an episode of confusion, agitation or delirium assessed by neurological examination
Hypercholesterolemia Between the baseline and the end of the treatment (week 48) (censored criterion) Occurrence of hypercholesterolemia requiring the introduction of lipid-lowering therapy (censored criterion)
Number of mycophenolate mofetil linked adverse events At the end of the treatment (week 48) Rate of patients who had at least one adverse effect of mycophenolate mofetil: persistent diarrhea, nausea, vomiting, abdominal pain , leukopenia, anemia, thrombocytopenia
Number of everolimus linked adverse events At the end of the treatment (week 48) Rate of patients who had at least one adverse effect of everolimus: ulcer, scar dehiscence, lower limb edema, hyperlipidemia, anemia, leukopenia, thrombocytopenia.