Kidney Transplantation
Conditions
Keywords
Immunosuppression, Kidney transplantation, everolimus, safety
Brief summary
The purpose of this study was to evaluate whether delayed (i.e. 28 ± 4 days post-transplant) administration of everolimus after transplantation reduces the risk of wound healing complications in comparison with immediate administration in de novo renal transplant patients (proportion of patients without wound/surgical complications related to initial transplant surgery) between randomization and 3 months after transplantation.
Interventions
Everolimus was provided in blisters containing 0.25 and 0.75 mg tablets and was taken orally.
Two 360 mg tablets were administered twice daily at 12-hour intervals. The tablets were swallowed whole in order to maintain the integrity of the enteric coating.
Cyclosporine was supplied as blisters containing 100 mg, 50 mg, 25 mg and 10 mg soft-gelatin capsules and was administered orally.
Steroids were administered according to local clinical practice.
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion criteria: * Patients who are willing and able to participate in the study and who provide written informed consent before performing any study related procedure; * Men or women ≥18 years at transplant; * Recipients of 1st or 2nd single kidney transplant from deceased donor or living unrelated/related donor \> 14 years; Key
Exclusion criteria
* Patients who are recipients of multiple organs transplant, including two kidneys; * Historical or current peak PRA \> 50%. Patients with already existing antibodies against the donor; * Thrombocytopenia (platelets \< 75,000/mm³), absolute neutrophil count \<1,500/mm³, leucopenia (leucocytes \< 2,500/mm³) or hemoglobin \< 7 g/dL; * Body mass index (BMI) \> 30 Kg/m2;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Without Wound Healing Complications - Worst-case Scenario | 3 months | The percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence, or study discontinuation due to any reason. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario | 3 months | The percentage of participants who experienced treatment failure was assessed. Treatment failure was defined as the occurrence of at least one failure event among death, graft loss or biopsy-proven acute rejection (BPAR). In the worst-case scenario, treatment failure was identified in one of the following cases: occurrence of at least one treatment failure event or study discontinuation due to any reason. |
| Patient Survival Rate: Percentage of Deaths - Worst-case Scenario | 3 Months, 12 months | The percentage of deaths was assessed. In the worst-case scenario, failure, i.e. death, was identified in one of the following cases: participant's death or study discontinuation due to any reason. |
| Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario | 3 months | The percentage of participants who experienced death or graft loss was assessed. In the worst-case scenario, failure, i.e. participants death or graft loss, was identified in one of the following cases: occurrence of at least one failure event or study discontinuation due to any reason. |
| Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario | 3 months, 12 months | The percentage of participants who experienced graft loss was assessed. In the worst-case scenario, failure, i.e. graft loss, was identified in one of the following cases: occurrence of graft loss or discontinuation due to any reason. |
| Percentage of Participants With BPAR - Worst-case Scenario | 3 Months, 12 months | A biopsy-proven acute rejection was defined as a biopsy graded IA, IB, IIA, IIB or III. In the worst-case scenario, failure, i.e. BPAR, was identified in one of the following cases: occurrence of BPAR or study discontinuation due to any reason. |
| Percentage of Participants With Delayed Graft Function (DGF) - | 3 Months | DGF was defined as the need for dialysis in the first week after transplant, excluding Renal Replacement Therapy within the first 24 hours after transplantation. |
| Duration of DGF | 3 months | The duration of DGF was defined as the elapsed time from first to last day of post-transplant dialysis. |
| Percentage of Participants Without Wound Healing Complications - Worst-case Scenario | 12 months | The percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence or study discontinuation due to any reason for participants who did not complete the 12 month follow-up visit. |
| Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT | baseline, 12 months | Renal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement. |
| Change From Baseline in Serum Creatinine - ITT | baseline, 3 months | Blood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement. |
| Change From Baseline in Serum Creatinine - Modified ITT | baseline, 12 months | Blood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement. |
| Percentage of Participants With Proteinuria | 3 months | Incidence of proteinuria (\>1,000 mg/day in urine collected in 24 hours or \> 1.0 if measured on the urine protein/creatinine concentration ratio in a spot urine sample) was assessed. |
| Percentage of Participants With Acute Rejection (AR) | 12 months | AR was defined as an episode of increased serum creatinine \>30% that was clinically diagnosed as an acute rejection but was not biopsy proven. |
| Percentage of Participants With a New Onset of Malignancy | 12 months | The percentage of participants with a new onset of malignancy was assessed. |
| Percentage of Participants With a New Onset of Diabetes | 12 months | The percentage of participants with a new onset of diabetes was assessed. |
| Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT | baseline, 3 Months | Renal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement. |
Countries
Italy
Participant flow
Recruitment details
This study included a 3 month treatment period followed by an observational follow-up period. Participants were treated as per local practice during follow-up and a follow-up evaluation was performed at 12 months.
Pre-assignment details
Participants were randomized in a 1:1 ratio to one of the 2 treatment groups.
Participants by arm
| Arm | Count |
|---|---|
| Immediate Everolimus (IE) Everolimus was started within 48 hours after graft reperfusion at a starting dose of 0.75 mg twice daily in combination with low-dose cyclosporine and steroids for 3 months. | 193 |
| Delayed Everolimus (DE) The standard dose of mycophenolate sodium was administered within 48 hours after graft reperfusion in combination with a full dose of cyclosporine and steroids. After28 +/- 4 days of treatment, mycophenolate sodium was discontinued and everolimus was introduced at a starting dose of 0.75 mg twice daily for 3 months. | 190 |
| Total | 383 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative issues | 2 | 1 |
| Overall Study | Death | 2 | 3 |
| Overall Study | Graft loss | 4 | 1 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | No conversion to everolimus | 0 | 24 |
| Overall Study | Protocol Violation | 0 | 4 |
| Overall Study | Withdrawal by Subject | 3 | 2 |
Baseline characteristics
| Characteristic | Immediate Everolimus (IE) | Delayed Everolimus (DE) | Total |
|---|---|---|---|
| Age, Continuous | 51.46 Years STANDARD_DEVIATION 11.37 | 51.19 Years STANDARD_DEVIATION 12.29 | 51.32 Years STANDARD_DEVIATION 11.82 |
| Sex: Female, Male Female | 59 Participants | 58 Participants | 117 Participants |
| Sex: Female, Male Male | 134 Participants | 132 Participants | 266 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 155 / 193 | 156 / 190 |
| serious Total, serious adverse events | 73 / 193 | 61 / 190 |
Outcome results
Percentage of Participants Without Wound Healing Complications - Worst-case Scenario
The percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence, or study discontinuation due to any reason.
Time frame: 3 months
Population: The safety population, which included all randomized participants who were treated and had at least one safety assessment, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants Without Wound Healing Complications - Worst-case Scenario | 68.39 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants Without Wound Healing Complications - Worst-case Scenario | 61.58 Percentage of participants |
Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT
Renal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement.
Time frame: baseline, 3 Months
Population: Participants from the ITT, who had both baseline and month 3 measurements, were included in the analysis for the month 3 time point. The ITT population included all randomized participants who were treated.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Immediate Everolimus (IE) | Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT | 38.64 mL/min | Standard Deviation 22.45 |
| Delayed Everolimus (DE) | Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT | 39.13 mL/min | Standard Deviation 21.46 |
Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT
Renal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement.
Time frame: baseline, 12 months
Population: Participants from the modified ITT, who had both baseline and month 12 measurements, were included in the analysis for the month 12 time point. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Immediate Everolimus (IE) | Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT | 41.26 mL/min | Standard Deviation 18.69 |
| Delayed Everolimus (DE) | Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT | 41.56 mL/min | Standard Deviation 19.9 |
Change From Baseline in Serum Creatinine - ITT
Blood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement.
Time frame: baseline, 3 months
Population: Participants from the ITT, who had both baseline and the post-baseline measurement for a given post-baseline time point, were included in the analysis for that post-baseline time point. The ITT population included all randomized participants who were treated.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Immediate Everolimus (IE) | Change From Baseline in Serum Creatinine - ITT | -4.79 mg/dL | Standard Deviation 2.74 |
| Delayed Everolimus (DE) | Change From Baseline in Serum Creatinine - ITT | -5.13 mg/dL | Standard Deviation 2.32 |
Change From Baseline in Serum Creatinine - Modified ITT
Blood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement.
Time frame: baseline, 12 months
Population: Participants from the modified ITT, who had both baseline and month 12 measurements, were included in the analysis for the month 12 time point. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Immediate Everolimus (IE) | Change From Baseline in Serum Creatinine - Modified ITT | -4.96 mg/dL | Standard Deviation 2.48 |
| Delayed Everolimus (DE) | Change From Baseline in Serum Creatinine - Modified ITT | -5.22 mg/dL | Standard Deviation 2.24 |
Duration of DGF
The duration of DGF was defined as the elapsed time from first to last day of post-transplant dialysis.
Time frame: 3 months
Population: Participants from the Intent-to-Treat (ITT) populations who required dialysis, 46 (23.83%) of the IE group and 60 (31.58%) of the DE group, were analyzed. The ITT population included all randomized participants who were treated.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Immediate Everolimus (IE) | Duration of DGF | 8.50 Days |
| Delayed Everolimus (DE) | Duration of DGF | 5.50 Days |
Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario
The percentage of participants who experienced graft loss was assessed. In the worst-case scenario, failure, i.e. graft loss, was identified in one of the following cases: occurrence of graft loss or discontinuation due to any reason.
Time frame: 3 months, 12 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Immediate Everolimus (IE) | Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario | 3 months | 6.74 Percentage of participants |
| Immediate Everolimus (IE) | Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario | 12 months | 7.25 Percentage of participants |
| Delayed Everolimus (DE) | Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario | 3 months | 18.42 Percentage of participants |
| Delayed Everolimus (DE) | Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario | 12 months | 19.47 Percentage of participants |
Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario
The percentage of participants who experienced death or graft loss was assessed. In the worst-case scenario, failure, i.e. participants death or graft loss, was identified in one of the following cases: occurrence of at least one failure event or study discontinuation due to any reason.
Time frame: 3 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario | 6.74 Percentage of participants |
| Delayed Everolimus (DE) | Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario | 18.42 Percentage of participants |
Patient Survival Rate: Percentage of Deaths - Worst-case Scenario
The percentage of deaths was assessed. In the worst-case scenario, failure, i.e. death, was identified in one of the following cases: participant's death or study discontinuation due to any reason.
Time frame: 3 Months, 12 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Patient Survival Rate: Percentage of Deaths - Worst-case Scenario | 6.22 Percentage of participants |
| Delayed Everolimus (DE) | Patient Survival Rate: Percentage of Deaths - Worst-case Scenario | 18.42 Percentage of participants |
Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario
The percentage of participants who experienced treatment failure was assessed. Treatment failure was defined as the occurrence of at least one failure event among death, graft loss or biopsy-proven acute rejection (BPAR). In the worst-case scenario, treatment failure was identified in one of the following cases: occurrence of at least one treatment failure event or study discontinuation due to any reason.
Time frame: 3 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario | 11.40 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario | 21.05 Percentage of participants |
Percentage of Participants With Acute Rejection (AR)
AR was defined as an episode of increased serum creatinine \>30% that was clinically diagnosed as an acute rejection but was not biopsy proven.
Time frame: 12 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants With Acute Rejection (AR) | 12.44 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With Acute Rejection (AR) | 10.53 Percentage of participants |
Percentage of Participants With a New Onset of Diabetes
The percentage of participants with a new onset of diabetes was assessed.
Time frame: 12 months
Population: Participants from the modified ITT, who had values at 12 months, were analyzed. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants With a New Onset of Diabetes | 3.14 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With a New Onset of Diabetes | 4.05 Percentage of participants |
Percentage of Participants With a New Onset of Malignancy
The percentage of participants with a new onset of malignancy was assessed.
Time frame: 12 months
Population: Participants from the modified ITT, who had values at 12 months, were analyzed. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants With a New Onset of Malignancy | 0 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With a New Onset of Malignancy | 0.68 Percentage of participants |
Percentage of Participants With BPAR - Worst-case Scenario
A biopsy-proven acute rejection was defined as a biopsy graded IA, IB, IIA, IIB or III. In the worst-case scenario, failure, i.e. BPAR, was identified in one of the following cases: occurrence of BPAR or study discontinuation due to any reason.
Time frame: 3 Months, 12 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants With BPAR - Worst-case Scenario | 3 monts | 11.40 Percentage of participants |
| Immediate Everolimus (IE) | Percentage of Participants With BPAR - Worst-case Scenario | 12 months | 15.54 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With BPAR - Worst-case Scenario | 3 monts | 21.05 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With BPAR - Worst-case Scenario | 12 months | 24.74 Percentage of participants |
Percentage of Participants With Delayed Graft Function (DGF) -
DGF was defined as the need for dialysis in the first week after transplant, excluding Renal Replacement Therapy within the first 24 hours after transplantation.
Time frame: 3 Months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants With Delayed Graft Function (DGF) - | 23.83 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With Delayed Graft Function (DGF) - | 31.58 Percentage of participants |
Percentage of Participants Without Wound Healing Complications - Worst-case Scenario
The percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence or study discontinuation due to any reason for participants who did not complete the 12 month follow-up visit.
Time frame: 12 months
Population: The safety population, which included all randomized participants who were treated and had at least one safety assessment, was analyzed.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants Without Wound Healing Complications - Worst-case Scenario | 65.80 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants Without Wound Healing Complications - Worst-case Scenario | 59.47 Percentage of participants |
Percentage of Participants With Proteinuria
Incidence of proteinuria (\>1,000 mg/day in urine collected in 24 hours or \> 1.0 if measured on the urine protein/creatinine concentration ratio in a spot urine sample) was assessed.
Time frame: 3 months
Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Immediate Everolimus (IE) | Percentage of Participants With Proteinuria | Yes | 4.15 Percentage of participants |
| Immediate Everolimus (IE) | Percentage of Participants With Proteinuria | No | 68.91 Percentage of participants |
| Immediate Everolimus (IE) | Percentage of Participants With Proteinuria | Missing | 26.94 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With Proteinuria | Yes | 4.21 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With Proteinuria | No | 68.42 Percentage of participants |
| Delayed Everolimus (DE) | Percentage of Participants With Proteinuria | Missing | 27.37 Percentage of participants |