Heart Transplantation, Kidney Transplantation, Liver Transplantation, Lung Transplantation
Conditions
Keywords
Heart Diseases, Kidney Diseases, Liver Diseases, Liver Failure, Lung Diseases, Transplant, Transplantation, Homologous, Rejection, Kidney Failure
Brief summary
Activity of genes in donor tissues that are involved in inflammation are thought to be involved with early organ dysfunction, increased immune responses in transplant recipients, and organ rejection. The purpose of this study is to determine the relationship between genetic expression in donor and recipient tissue with transplant survival. Participants in this study will have received heart, lung, liver, or kidney transplants.
Detailed description
Inflammation and injuries to transplanted organs during the immediate post-operative period may be linked to early organ dysfunction and higher rates of transplant rejection in the recipient. Currently, mRNA expression of proinflammatory genes in donor tissues is thought to be a risk factor for early organ transplant dysfunction, increased expression of the recipients cell-mediated immunity genes, and organ rejection. The purpose of this study is to test the association between proinflammatory mRNA expression in donor samples and subsequent development of early organ dysfunction in kidney, lung, and liver transplant recipients. This study will also test the effects of proinflammatory mediators expressed in the transplanted organ pre- and post-reperfusion on organ rejection and genes expressed in cell mediated immune responses. This will be achieved by identifying the proinflammatory immune responses and their mechanisms. This study will consist of up to 11 study visits over a period of 2 years. The baseline visit will occur 24 hours prior to organ transplantation. Follow-up visits will occur daily for Days 1 to 3 (for lung transplant recipients only) and on Day 7, Week 6, and Months 3, 6, 9, 12, 18, and 24 post-transplant. At the baseline visit, a physical exam, medical history, demographics, vital signs measurements, blood collection, and collection of donor tissue sample will occur. For most or all other study visits, medication and adverse events tracking and blood collection will occur. Depending on the transplant type, participants will undergo the following procedures: * Heart: Participants will undergo a heart biopsy that is part of standard clinical care following a heart transplant. An echocardiogram and an electrocardiogram will occur at most visits. * Kidney: Renal biopsies will be performed 1 hour after reperfusion at the time of surgery. Urine collection will occur at most visits. * Liver: Liver biopsies will be performed at the time of procurement and within 1 hour of reperfusion. * Lung: Participants will undergo bronchoalveolar lavage that is part of standard clinical care following a lung transplant. A chest x-ray, an arterial blood gas test, a pulmonary function test, and 6-minute walking test will occur at some visits.
Interventions
None listed
Sponsors
National Heart, Lung, and Blood Institute (NHLBI)
National Institute of Allergy and Infectious Diseases (NIAID)
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 70 Years
Healthy volunteers
No
Inclusion criteria
for all participants: * Received single lung, heart, kidney, or liver transplant * Specimens of donor tissues have been collected * Parent or guardian willing to provide informed consent, if applicable Inclusion Criteria for Kidney or Liver Transplant Participants: * 70 years old or younger Inclusion Criteria for Heart or Lung Transplant Participants: * Between 16 and 70 years old
Exclusion criteria
for All Participants: * Previous solid organ transplant * Need for combined organ transplant * HIV or hepatitis C virus infection * Recipient of an organ from a hepatitis C virus-infected donor * Clinical evidence of systemic bacterial infection in the recipient at the time of transplantation * Living donor transplant recipient of either a kidney, liver, or lung
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Association between proinflammatory mRNA expression in donor samples and subsequent development of early organ dysfunction in the immediate period following transplantation | Within first 7 days after transplant |
| Association of mRNA expression of proinflammatory mediatros in the transplanted organ in the immediate pre and post-reperfusion period with subsequent incidence of acute rejection and expression of genes involved in cell mediated immunity | 12 months after transplant |
Countries
United States
Outcome results
None listed