Extended Follow-Up After Islet Transplantation in T1D
The purpose of this study is to provide patients who have received at least one islet transplant as a previous participant in a Clinical Islet Transplantation Consortium (CIT) clinical trial with maintenance immunosuppressive medications and to collect information about the safety of the medications and islet function.
Type 1 Diabetes (T1D)
Drug: Maintenance Immunosuppressive Treatment
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Extended Follow-Up After Islet Transplantation in Type 1 Diabetes (CIT-08)|
- Duration of sustained islet allograft function [ Time Frame: Month 36,48,60,72,84,96,108,120,132 and 144 status post last islet transplant ] [ Designated as safety issue: Yes ]A C-peptide >/= 0.3 ng/mL at 0, 60, or 90 minutes after a Mixed-Meal Tolerance Test (MMTT) will be considered evidence of insulin production by transplanted islets
- Serum creatinine and calculated eGFR at each annual study visit [ Time Frame: Month 36,48,60,72,84,96,108,120,132 and 144 status post last islet transplant ] [ Designated as safety issue: Yes ]Measured as part of each annual follow-up evaluation
- Incidence of serious adverse events (SAEs) during the 12-month period preceding each annual study visit [ Time Frame: Month 36,48,60,72,84,96,108,120,132 and 144 status post last islet transplant ] [ Designated as safety issue: Yes ]Insulin usage will be estimated from the one-week self report values
- Insulin requirements during a one-week period preceding each annual study visit [ Time Frame: Month 36,48,60,72,84,96,108,120,132 and 144 status post last islet transplant ] [ Designated as safety issue: No ]Insulin usage will be estimated from the one-week self report values
- Incidence of severe hypoglycemic events during the 12-month period preceding each annual study visit [ Time Frame: 36 months, 48 months, 60 months, 72 months, 84 months, 96 months, 108 months, 120 months, 132 months and 144 months ] [ Designated as safety issue: Yes ]Numbers of severe hypoglycemic events will be estimated from the self report values obtained at each follow-up visit. Defined as an event with one of the following symptoms: memory loss; confusion; uncontrollable behavior; irrational behavior; unusual difficulty in awakening; suspected seizure; seizure; loss of consciousness; or visual symptoms, in which the subject was unable to treat him/herself and which was associated with either a blood glucose level <54 mg/dL (3.0 mmol/L) or prompt recovery after oral carbohydrate, IV glucose, or glucagon administration.
- HbA1c levels at each annual study visit [ Time Frame: Month 36,48,60,72,84,96,108,120,132 and 144 status post last islet transplant ] [ Designated as safety issue: No ]Glycosylated hemoglobin test determination during each follow-up visit
- Incidence of all-cause mortality [ Time Frame: By month 144 status post last islet transplant ] [ Designated as safety issue: No ]
- Donor-specific alloantibodies [ Time Frame: By month 144 status post last islet transplant ] [ Designated as safety issue: No ]Subjects with confirmed graft failure will continue with annual study visits; however, metabolic assessments should not be completed. Subjects who were enrolled in islet-alone parent studies and who experience graft failure and subsequently stop immunosuppression will have alloantibody assessed 3 months after their last dose of immunosuppression.
Biospecimen Retention: Samples With DNA
Participants are given the option to provide consent for:
- the collection and storage of blood samples for future research studies
- the collection and storage of blood samples for future genetic (i.e., DNA) testing.
|Study Start Date:||May 2011|
|Estimated Study Completion Date:||July 2018|
|Estimated Primary Completion Date:||July 2018 (Final data collection date for primary outcome measure)|
CIT Islet Transplantation Recipients
Subjects who received an islet-cell transplant for Type 1 Diabetes (T1D) while enrolled in one of the Clinical Islet Transplantation (CIT) parent studies and continue to have islet graft function. All subjects will continue immunosuppressive medications under CIT08. Detailed follow-up evaluations including but not limited to islet function will occur on an annual basis.
The immunosuppressive medications (e.g., tacrolimus, sirolimus, cyclosporine, mycophenolate mofetil [MMF], mycophenolic sodium) in this study are obtained by prescription unless provided by the study through the drug distributor. Generic brands are allowed, when available. Antibacterial, antifungal, and antiviral prophylaxis, insulin therapy, and other standard therapies will be provided per site-specific practices.
Drug: Maintenance Immunosuppressive Treatment
All immunosuppressive and immunomodulatory therapies are used presently to prevent rejection of transplanted islet cells. The agents listed are those used in the parent trials and continued in this trial, CIT08.
After islet-cell transplantation in the CIT studies*, each subject receives maintenance immunosuppressive medications.
The purpose of this protocol is to collect additional follow-up for safety and efficacy from CIT subjects with graft function after their completion in their CIT parent study. It is expected that most subjects will retain measurable islet function and, in the islet-alone studies, continue to receive immunosuppressive medications at the time of completing their CIT parent study.
*CIT parent studies: CIT02 (NCT00464555), CIT03 (NCT00434850), CIT04 (NCT00468403), CIT05 (NCT00468442), CIT06 (NCT00468117), and CIT07 (NCT00434811)
Please refer to this study by its ClinicalTrials.gov identifier: NCT01369082
|United States, California|
|University of California, San Francisco|
|San Francisco, California, United States, 94143|
|United States, Florida|
|University of Miami|
|Miami, Florida, United States, 33136|
|United States, Georgia|
|Atlanta, Georgia, United States, 30322|
|United States, Illinois|
|Chicago, Illinois, United States, 60611|
|University of Illinois|
|Chicago, Illinois, United States, 60612|
|United States, Massachusetts|
|Massachusetts General Hospital|
|Boston, Massachusetts, United States, 02493|
|United States, Minnesota|
|University of Minnesota|
|Minneapolis, Minnesota, United States, 55455|
|United States, Pennsylvania|
|University of Pennsylvania|
|Philadelphia, Pennsylvania, United States, 19104|
|Principal Investigator:||Bernhard Hering, MD||University of Minnesota - Clinical and Translational Science Institute|
|Principal Investigator:||Ali Naji, PhD||University of Pennsylvania|
|Principal Investigator:||Camillo Ricordi, MD||University of Miami|
|Principal Investigator:||Andrew Posselt, MD, PhD||University of California, San Francisco|
|Principal Investigator:||Nicole Turgeon, MD||Emory University|
|Principal Investigator:||Xunrong Luo, MD, PhD||Northwestern University|