rATG Versus rATG Combined With Intravenous Immunoglobulin (IVIG) Induction Immunosuppression in HLA Incompatible Transplantation (INHIBIT)

rATG Versus rATG Combined With IVIG Induction Immunosuppression in HLA Incompatible Transplantation

Brief Summary:
This study aims to prove similar efficacy of PE/rATG (intervention) and PE/rATG/IVIG (centre standard of care) induction regimens to prevent biopsy proven antibody-mediated changes and TCMR as composite endpoint within 12 months after HLA incompatible kidney transplantation.

Detailed Description:
There have been no published clinical studies evaluating rATG/IVIG induction protocol in comparison with rATG alone in defined cohort of HLA incompatible kidney transplant recipients. Prescribing IVIG in management of prevention of transplant rejection is considered off-label use, however IVIG remains part of induction protocols in many transplant centres. IVIG therapy is demanding due to high cost and limited resources of these human origin products. Trial participants will be end-stage renal disease (ESRD) patients listed for deceased donor / living donor kidney transplantation with anti HLA antibody screening performed within 12 months before transplantation and with last DSA 1 000 - 5 000 Mean Fluorescence Intensity (MFI) and negative CDC (Complement-dependent cytotoxicity crossmatch test) prior to transplantation. Participants will be randomized into one of the treatment groups (PE/PP(Plasmapheresis) + rATG + IVIG, PE/PP + rATG) and as a primary outcome a composite endpoint defined as occurrence of antibody- or T-cell mediated rejection within 12 months after transplantation will be evaluated.


Study Type: Interventional (Clinical Trial)
Estimated Enrollment: 138 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The present study is a prospective randomized single-centre open-label two-arm Phase III.b non-inferiority clinical trial. This trial aims to prove similar efficacy of PE/rATG and PE/rATG/IVIG (centre standard of care) induction regimens to prevent biopsy proven antibody-mediated changes and TCMR as composite endpoint within 12 months after HLA incompatible kidney transplantation.
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: rATG Versus rATG Combined With IVIG Induction Immunosuppression in HLA Incompatible Transplantation
Estimated Study Start Date: March 15, 2020
Estimated Primary Completion Date: April 15, 2021
Estimated Study Completion Date: April 15, 2023

Arm:
- Placebo Comparator: PE/rATG
- Active Comparator: PE/rATG/IVIG

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