Quantitative Detection of Circulating Donor-Specific DNA in Organ Transplant Recipients (DTRT-Multi-Center Study) (DTRT)
The primary goal of this Multicenter Study is to develop and to evaluate a method for measuring donor-specific cell free DNA in blood samples from transplant recipients as markers of rejection. Blood samples obtained periodically from heart transplant recipients are assessed for cell free DNA relative to clinical data in order to determine whether changes in the level of cell free DNA indicate rejection.
This research study proposes testing a blood sample obtained from the heart transplant recipient. The research seeks to establish whether this blood test will show when the patient is beginning to or already rejecting the transplanted heart.
BACKGROUND Identifying if a transplant patient is beginning to or already rejecting the heart is necessary, so that appropriate treatment can be started to halt the rejection. Heart catheterization with biopsy is the usual method used for assessing whether a patient may be rejecting the heart. There are also a number of other methods that transplant physicians will use to look for signs of rejection including other blood tests, echocardiograms, obtaining pressure readings during heart catheterization, and micro-array testing of blood obtained during biopsy. These technologies are limited in ability to consistently and accurately identify the presence of rejection.
The usual method of checking for rejection involves obtaining a sample of the heart tissue (heart biopsy); biopsy can only be accomplished through heart catheterization which is an invasive procedure that has risks associated with disturbing the heart such as puncturing the heart or causing the heart rate to change or damaging tissue in the heart. Overtime, repeating this invasive procedure can diminish the ease of the procedure because the veins can become scarred and more difficult to access. For these reasons, researchers believe that it would be good to have a blood test that gives information about the possibility of rejection so that it may not be necessary to do as many heart biopsies. Also, a blood test may be able to provide information about the heart or about rejection that is currently not available at all.
|Cardiovascular Disease Acute Rejection of Cardiac Transplant Cardiac Transplant Rejection Heart Transplant Failure and Rejection||Diagnostic Test: Blood Draw of up to 10 ml|
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Quantitative Detection of Circulating Donor-Specific DNA in Organ Transplant Recipients (DTRT-Multi-Center Study)|
- Assay and laboratory protocol development and optimization. [ Time Frame: Year 1-5 ]To develop and optimize an assay and protocol to detect donor-specific cell free DNA from recipient plasma.
- Biomarker Development [ Time Frame: Year 1-3 ]To determine the threshold of elevation of circulating donor specific cell free DNA (cfDNA)
- Validation [ Time Frame: Years 4-5 ]To validate the threshold and predictive model to evaluate sensitivity and specificity.
Biospecimen Retention: Samples With DNA
|Study Start Date:||September 2013|
|Estimated Study Completion Date:||May 2018|
|Estimated Primary Completion Date:||May 2018 (Final data collection date for primary outcome measure)|
Heart Transplant Recipients
Up to 10 cc of blood will be drawn from heart transplant recipients at various time points prior to and after transplant. Blood draw is the only research activity that study participants will undergo. In addition to blood draw, data will be collected from clinical records representing the participant's transplant course such as the medical record, imaging, and biopsy slides with pathology reports.
Diagnostic Test: Blood Draw of up to 10 ml
In a laboratory setting, the blood will be spun for plasma and buffy coat, DNA will be extracted for processing using the diagnostic test. The results of the test are not provided back to the clinical setting.
Early detection of rejection is a major focus of organ transplant care. The use of aggressive immunosuppressive therapy has been shown to alter the prognosis of heart transplant patients who have acute rejection1. There are many modalities utilized in the routine surveillance of heart transplant patients, each with limitations. Screening transthoracic echocardiography focusing on indices of systolic and diastolic dysfunction, along with regional wall abnormalities, has been shown to have poor sensitivity and does not effectively discriminate between patients with and without rejection. Newer echocardiographic parameters including myocardial performance or diastolic velocity indices may be a better means of detecting subtle changes in cardiac function in the setting of heart transplant, but these tools are most helpful after the insult caused by rejection has already occurred. Hemodynamic changes measured during heart catheterization have also been evaluated as a means of detecting rejection. Rosenthal et al found that although there were statistically significant differences between patients with higher or lower grades of rejection scores, heart catheterization did not permit effective discrimination of patients with moderate to severe rejection. Heart biomarkers, including c-reactive protein, brain natriuretic peptides, and troponin, have been studied as non-invasive measures of determining heart dysfunction or rejection. These surrogates are weakly associated with different rejection grades on biopsy and have a poor predictive capacity for biopsy-detected rejection3. Recently, microarray technology has been used to screen for genes expressed in heart allograft rejection using peripheral leukocytes from blood samples obtained at the time of endomyocardial biopsy. This technique was shown to have a high negative predictive value for the diagnosis of acute cellular rejection but it is unable to detect low grades of rejection4. Overall, these technologies are limited in the ability to consistently and accurately predict the presence of rejection and have low positive predictive values when compared to biopsy.
The current gold standard in detection of rejection is the use of endomyocardial biopsy. Attaining these samples is invasive and long term repeated central venous access can be difficult. Risk of endomyocardial biopsy includes perforation leading to cardiac tamponade, arrhythmias including atrial fibrillation, pneumothorax, hemothorax, and valvular regurgitation secondary to rupture of chordae or damage to valve leaflets themselves. There is variability in pathological interpretation of histologic grades, especially at higher grades of rejection due to the difficulty in interpretation of nodular infiltrates. The 2005 revised ISHLT grading system has simplified the grading system of cellular rejection and now includes assessment of antibody mediated rejection. This may improve the utility of endomyocardial biopsy, but much controversy still exists on the method of grading rejection and its clinical implications. Thus, the development of a noninvasive, relatively inexpensive method that accurately predicts the presence of rejection is critical.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02109575
|Contact: Anne L Laulederkind, BSN, BA||(414) firstname.lastname@example.org|
|United States, Arkansas|
|Arkansas Children's Hospital||Recruiting|
|Little Rock, Arkansas, United States, 72202|
|Contact: Ginger Gilmore, MCSc, APN 501-364-4292 Gilmore.Ginger@uams.edu|
|Contact: Denise Graves 501-364-2237 Graves.Denise@uams.edu|
|Principal Investigator: Kenneth R Knecht, MD|
|United States, Georgia|
|Atlanta, Georgia, United States, 30322|
|Contact: Susie Gentry, BSN, BBA, BS 404-785-6953 email@example.com|
|Contact: Allison Wellons, BS, RN 404-785-6459 firstname.lastname@example.org|
|Principal Investigator: Shriprasad Deshpande, MD|
|United States, Illinois|
|Lurie Children's Hospital||Not yet recruiting|
|Chicago, Illinois, United States, 60611|
|Contact: Kathleen Van't Hof 312-227-1549 email@example.com|
|Principal Investigator: Elfrieda Pahl, MD|
|United States, New York|
|New York, New York, United States, 10032|
|Contact: Cristina Falo, PhD 212-305-3839 firstname.lastname@example.org|
|Principal Investigator: Marc Richmond, MD|
|United States, North Carolina|
|Durham, North Carolina, United States, 27711|
|Contact: Sarah Casalinova 919-613-5621 Sarah.Casalinova@dm.duke.edu|
|Principal Investigator: Jacob N Schroder, MD|
|United States, Tennessee|
|Nashville, Tennessee, United States, 37212|
|Contact: Karen Trochez 615-343-6021 karen.m.trochez@Vanderbilt.Edu|
|Principal Investigator: David Bichell, MD|
|Principal Investigator: Mark Wigger, MD|
|United States, Wisconsin|
|Children's Hospital of Wisconsin||Recruiting|
|Milwaukee, Wisconsin, United States, 53226|
|Contact: Gail Stendahl, NP 414-266-5775 GStendahl@chw.org|
|Contact: Julie Schmidt, NP 414-266-5740 JSchmidt@chw.org|
|Principal Investigator: Steven Kindel, MD|
|Milwaukee, Wisconsin, United States, 53226|
|Contact: Susan K Mauermann, RN, CRCC 414-955-6749 email@example.com|
|Contact: Janet Gosset, RN 414-955-6784 firstname.lastname@example.org|
|Principal Investigator: Nunzio Gaglianello, MD|
|Principal Investigator:||Michael Mitchell, MD||Medical College of Wisconsin|
|Principal Investigator:||Aoy Tomita-Mitchell, PhD||Medical College of Wisconsin|