Novel Cooling Device for the Elimination of Warm Ischemia During Renal Transplantation
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 45
- 试验地点
- 1
- 主要终点
- Part A: Device design is deemed suitable to move into the traditional feasibility stage (Part B of protocol)
研究概览
简要总结
Avoiding warm ischemia time during vascular anastomosis of the renal allograft is important to prevent damage. The investigators are studying a cooling device that may control the temperature of the renal allograft during transplant surgery; attempting to keep temperatures at or below 5°C for at least 60 minutes. If found effective, this could eliminate warm ischemia and potentially prevent damage to transplanted kidneys.
详细描述
Warm ischemia can damage a renal allograft in many different ways often leading to early failure of the kidney transplant and sometimes even death of the transplant recipient. For this reason every effort is made to keep the allograft cold during the removal and transportation, and protocols have been developed to ensure this. Although kidneys are kept below 5°C during transportation, they re-warm rapidly during the transplant surgery. On average, kidneys are exposed to 40 or more minutes of dangerously warm temperatures during transplant surgery.
To avoid damage, it is important to reduce the amount of time it is exposed to warm temperatures. Currently, there are no devices or standardized protocols available to ensure a kidney stays cold during the transplant surgery.
The Principal Investigator has developed Kidney Skinn, a device that may control the temperature of the renal allograft during transplant surgery; keeping allograft temperatures at or below 5°C for at least 60 minutes. If found effective, this could eliminate warm ischemia and potentially prevent damage to transplanted kidneys. The device may also potentially provide retraction and support for the kidney during the transplant operation, making the surgery easier to perform. Additionally, the device may be found to be easily removed once the transplant is complete.
A previous study was conducted with the Kidney Skinn in animals; the next step is to investigate whether the device can perform in the human clinical setting. This study will be done in 2 steps. Part A: a series of consecutive consenting patients to determine device initial safety, and Part B: a single-centre randomized-controlled pilot study of kidney transplant recipients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Device Feasibility
- 盲法
- Double (Participant, Care Provider)
入排标准
- 年龄范围
- 18 Years 至 —(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •≥18 years of age at time of transplant
- •Slated to receive a single cadaveric organ
- •Donor declared by traditional neurological determination of death (NDD)
- •Standard criteria donor (SCD) or Extended criteria donor (ECD)
- •Consent obtained prior to the transplant operation
排除标准
- •Living donor (LD)
- •Donor after cardiocirculatory death (DCD)
- •Highly sensitized patients (those with Panel-reactive antibody or PRA >80%)
- •Recipient of a previous kidney transplant
研究组 & 干预措施
Surgery utilizing the Kidney Skinn cooling device
All patients in Part A, and those randomized to the Kidney Skinn arm in Part B, will receive transplant surgery in the traditional fashion with the exception that the renal allograft will be placed in the cooling device at the initiation of the vascular anastomosis. Cold saline irrigation flowing through the device will be used to maintain renal hypothermia for the duration for the vascular anastomosis. After the vascular clamps are released, the device will be removed.
干预措施: Kidney cooling device (Device)
Standard transplant surgery practice
Standard transplant surgery per site practice
结局指标
主要结局
Part A: Device design is deemed suitable to move into the traditional feasibility stage (Part B of protocol)
时间窗: 6 months
The Kidney Skinn cooling device can be utilized during vascular anastomosis, and the ability of the device to maintain surface and core temperatures of transplant kidneys at \<5ºC for the duration of the vascular anastomosis.
Part B: To determine the feasibility of a trial using the Kidney Skinn cooling device to usual care to ameliorate warm ischemia time during kidney transplantation
时间窗: 2 years
Feasibility Outcomes will include the following: 1. Ability to randomize \>60% of eligible patients 2. \>75% of patients randomized to the Kidney Skinn arm use the device 3. 70% of patients randomized to the device (Kidney Skinn) achieve a renal allograft surface temperature of \<5C for the duration of the vascular anastomosis.
次要结局
- Proportion of patients who develop delayed graft function (need for dialysis in the first week after transplantation) compared with usual care(7 days)
- Differences in achieved renal allograft surface temperature comparing the Kidney Skinn (intervention arm) versus usual care (control arm)(60 minutes)
- Difference in ischemia-reperfusion injury biomarker levels between the intervention and control groups(7 days)
- Serum creatinine level at discharge from initial hospitalization for transplantation(5-7 days)
研究者
Thomas Skinner
Principal Investigator
Nova Scotia Health Authority
