Diagnosis of Acute Rejection in Renal Transplant Patients by Urine Mass Spectrometry
Reliable and timely detection of acute rejections in renal transplant patients is important to preserve the graft function and to prevent premature graft failure. The current gold standard for the rejection diagnosis is a renal biopsy which is usually performed upon an unexplained decline in the graft function (determined by serum creatinine or clearance). Because of the insensitivity of creatinine determinations and the invasiveness of renal biopsies, non-invasive tests have been suggested to diagnose acute rejection including mass spectrometry (MS) analysis of urine samples.
The ability of MS analysis to detect acute rejection has been demonstrated in small studies on selected patients but evidence is lacking that this test is efficacious in the routine setting of the post-transplant patient care. Based on our previous work that established urine peptide sets for acute rejection by MS, a prospective, multicentre diagnostic phase III study will be executed.
The aim of the study is to prove that this test is as equally effective as the allograft biopsy to detect acute rejection in patients that undergo a biopsy for unexplained renal dysfunction. The perspective of this approach is that the test could be used either in place of the biopsy or as decision guidance whether a biopsy is necessary to confirm the presence of rejection. Another perspective is that the MS test (respectively, a simplified test system derived from this method) could be used in the regular post-transplant surveillance for acute rejection, in place of the relatively insensitive procedure with periodic monitoring of the graft function by creatinine determinations.
Rejection of Renal Transplant
|Study Design:||Observational Model: Cohort
Time Perspective: Cross-Sectional
|Official Title:||Non-invasive Diagnosis of Acute Rejection in Renal Transplant Patients Using Mass Spectrometry of Urine Samples - a Multicentre Diagnostic Phase III Trial|
- Ability of the urine mass spectrometry test to diagnose acute renal allograft rejection, compared to the gold standard 'allograft biopsy' [ Time Frame: Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day) ] [ Designated as safety issue: No ]
In patients with unexplained renal allograft dysfunction who get an allograft biopsy to clarify if an acute rejection is present, a simultaneous urine sample will be taken.
The peptide pattern of this urine sample is analyzed by mass spectrometry and a diagnosis is made (rejection present/not present) based on a pre-defined peptide pattern which was established to detect acute allograft rejection.
In the primary outcome analysis, the sensitivity and specificity of the rejection diagnosis by the urine test is compared to the diagnosis made by the allograft biopsy.
- Sensitivity and specificity of the urine test to diagnose acute renal allograft rejection in subgroups with different severity grades of the rejection [ Time Frame: Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day) ] [ Designated as safety issue: No ]Sensitivity/specificity measures for the urine test will be determined in subgroups of patients with different severity of the rejection. Severity grading is based on the pathomorphological classification of the rejection (according to the BANFF classification) and on the functional impairment of the allograft at the time of rejection diagnosis.
- Sensitivity and specificity of the urine test to diagnose acute renal allograft rejection in subgroups with kidney transplantation alone and with combined pancreas/kidney transplantation [ Time Frame: Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day) ] [ Designated as safety issue: No ]Sensitivity/specificity measures for the urine test will be determined in subgroups of patients who have a kidney transplant or a combined pancreas/kidney transplant.
- Sensitivity and specificity of the urine test to diagnose acute renal allograft rejection in subgroups with concurrent infection [ Time Frame: Results of the urine test will be assessed in relation to the simultaneously performed allograft biopsy (1 day) ] [ Designated as safety issue: No ]Sensitivity/specificity measures for the urine test will be determined in subgroups of patients who have concurrent infections at the time of the biopsy and urine sampling such as cytomegaly virus, polyoma virus, and urinary tract infection. The analysis intends to identify potential interference of these conditions with the urine mass spectrometry test.
Biospecimen Retention: Samples Without DNA
Urine samples, kidney allograft biopsies
|Study Start Date:||October 2011|
|Estimated Study Completion Date:||December 2015|
|Estimated Primary Completion Date:||December 2015 (Final data collection date for primary outcome measure)|
Please refer to this study by its ClinicalTrials.gov identifier: NCT01315067
|Contact: Wilfried Gwinner, Prof./MD||+49-511-532- ext firstname.lastname@example.org|
|RTW University of Aachen||Recruiting|
|Aachen, Germany, 52074|
|Contact: Anja Muehlfeld, MD +49-241-8035652|
|Contact: Astrid Kranz, Study Nurse email@example.com|
|Principal Investigator: Anja Mühlfeld, Dr. med.|
|Sub-Investigator: Gisela Kroll, MD|
|Charite Universitätsmedizin Berlin||Recruiting|
|Berlin, Germany, 10117|
|Contact: Klemens Budde, M.D. +49-30 450 514 ext 286 firstname.lastname@example.org|
|Contact: Alma Rustemi +49-30 450 514 ext 286 email@example.com|
|Sub-Investigator: Daniela Klonower, M.D.|
|University of Erlangen-Nuremberg||Recruiting|
|Erlangen, Germany, 90154|
|Contact: Yvonne Thoss, Study Nurse +49-9131-8534149|
|Principal Investigator: Michael Wiesener, MD|
|Sub-Investigator: Karl Hilgers, MD|
|Sub-Investigator: Roudolf Poliak, MD|
|Sub-Investigator: Johannes Jacobi, MD|
|Sub-Investigator: Sabine Jank, MD|
|Sub-Investigator: Michaela Streubert, MD|
|Essen, Germany, 45147|
|Contact: Felix Testroet, Study Nurse +49-201 72383242|
|Principal Investigator: Andreas Kribben, MD|
|Sub-Investigator: Oliver Witzke, MD|
|Sub-Investigator: Ulrike Wieneke, MD|
|Sub-Investigator: Stefan Becker, MD|
|Sub-Investigator: Thorsten Feldkamp, MD|
|Sub-Investigator: Tobias Türk, MD|
|Hannover Medical School||Recruiting|
|Hannover, Germany, 30625|
|Contact: Elisabeth Bahlmann, Study Nurse +49-511-532-3000|
|Principal Investigator: Wilfried Gwinner, Prof./MD|
|Sub-Investigator: Armin Koch, Prof. Dr.|
|Sub-Investigator: Antonia Zapf, Dr.|
|Jena, Germany, 07747|
|Contact: Christiane Rüster, MD +49-3641-9324 ext 300|
|Principal Investigator: Gunter Wolf, MD|
|Sub-Investigator: Undine Ott, MD|
|Sub-Investigator: Christiane Rüster, MD|
|Kliniken der Stadt Köln gGmbH||Recruiting|
|Köln, Germany, 51109|
|Contact: Petra John, Study Nurse +49-221-8907-0|
|Principal Investigator: Wolfgang Arns, MD|
|Sub-Investigator: Andrea Huppertz, MD|
|Sub-Investigator: Katja Josefiak, MD|
|Sub-Investigator: Benno Kitsche, MD|
|Sub-Investigator: Robert Schuhmann, MD|
|München, Germany, 81377|
|Contact: S Gohr, Study Nurse +49-89-70953961|
|Principal Investigator: Michael Fischereder, MD|
|Sub-Investigator: Antje Habicht, MD|
|Principal Investigator:||Wilfried Gwinner, Prof. /MD||Hannover Medical School|