Kidney Transplant
Conditions
Keywords
Kidney Transplantation, infliximab, Tissue Donors, Remicade, Induction Therapy, Deceased Donor Kidney Transplant Recipients
Brief summary
During transplant surgery, there is a period of time when a donated kidney is removed from a donor's body and stored until the time of the transplant surgery. The storage procedure results in buildup of various proteins within the kidney that can injure the donated kidney after it is transplanted. One of these proteins is tumor necrosis factor-alpha (TNF-alpha). The purpose of this study is to evaluate whether taking infliximab, which blocks tumor necrosis factor alpha (TNF-alpha), just prior to transplant surgery, along with usual transplant medicines will protect the donated kidney from damage caused by TNF-alpha and help keep the transplanted kidney healthy for a longer period of time.
Detailed description
This is a Phase 2, multicenter, randomized, double blind (masked), placebo-controlled, 2-arm clinical trial of 300 deceased donor kidney transplant recipients. Participants will be randomized (1:1) to the experimental or control arm (150 subjects per arm).
Interventions
A single dose, of 3mg/kg infusion
500mg will be Initiated just prior to or at the initiation of transplant surgery and prior to Infliximab and thymoglobulin infusion
Administered at a target dose of 2000mg daily, as tolerated, until study closure
Administered at a target dose of 0.1mg/kg BID, post-op, then adjusted to target trough levels of 8-12ng/ml during 1st 3-months post-op and finally adjusted to target trough levels of 5-8ng/ml until study closure
Administered daily for 5 days with the intention of achieving a total dose of 4.5 to 6.0 mg/kg, as tolerated
30 to 60 minutes prior to the start of the infusion * Tylenol, 600 to 1000mg by mouth or * Suppository form
30 to 60 minutes prior to the start of the infusion * Claritin (Loratadine) 10mg by mouth or * Benadryl (Diphenhydramine) 25 or 50 mg by mouth
A single dose is volume matched to Infliximab (250mL) infusion
Prednisone will be administered peri-operatively according to center practice. Prednisone should be gradually tapered to no less than 5 mg/day or 10 mg every other day by 3 months post-transplant thereafter until study closure.
30 to 60 minutes prior to the start of the infusion * Claritin (Loratadine) 10mg by mouth or * Benadryl (Diphenhydramine) 25 or 50 mg by mouth
Sponsors
Study design
Eligibility
Inclusion criteria
1. Adult (\>18 years of age) male and female recipients (all races and ethnicities) 2. Subject must be able to understand and provide consent 3. Recipients of deceased donor kidney transplants (including re-transplants) 4. Negative crossmatch, actual or virtual, or a PRA of 0% on historic and current sera as determined by each participating study center 5. Donor kidneys from deceased donors and donors after cardiac death (DCD) with Kidney Donor Profile Indices (KDPI) ranging from ≥20 to \<95 6. Female participants of childbearing potential must have a negative pregnancy test upon study entry 7. Subjects must have a negative test result for latent tuberculosis (TB) infection (PPD, QuantiFERON, ELISPOT): * Subjects who have a negative test result for latent TB infection within 1 year of transplant date are eligible for enrollment and no further action is required * Subjects who have a negative test for latent TB infection that is greater than 1 year old are eligible for enrollment but are required to have a repeat test prior to transplantation.
Exclusion criteria
1. Inability or unwillingness of a participant to give written informed consent or comply with study protocol 2. Recipients of living donor transplants 3. Presence of other transplanted solid organ (heart, lung, liver, pancreas, small intestines) or co-transplanted organ 4. Human immunodeficiency virus positive (HIV+) recipients 5. Epstein-Barr virus Immunoglobulin G (EBV IgG) negative recipients 6. Hepatitis B surface antigen positive kidney transplant recipients 7. Hepatitis B core antibody positive kidney transplant recipients 8. Hepatitis B negative kidney transplant recipients that receive transplants from Hepatitis B core antibody positive donor 9. Hepatitis C Virus positive (HCV+) patients who are either untreated or have failed to demonstrate sustained viral remission for more than 12 months after anti-viral treatment 10. Recipients with a previous history of active TB 11. Recipients with a positive test for latent TB infection (PPD, QuantiFERON, ELISPOT), regardless of previous therapy 12. Any severe infection at the time of transplantation. --Note: Severe infection determination will be made by the local site investigator. 13. Severe congestive heart failure (NYHA functional class III or higher) 14. Subjects with a known hypersensitivity to any murine/ mouse proteins 15. Subjects with any history of receiving any anti-tumor necrosis factor (anti- TNF) products 16. Subjects in whom rabbit anti-thymocyte globulin (Thymoglobulin®) or infliximab might not be tolerated 17. Subjects with a white blood cell count less than 3000/mm\^3 18. Subjects with a platelet count less than 100,000/mm\^3 19. Subjects with systolic blood pressure \<100 mm/Hg 20. Subjects with symptomatic orthostatic hypotension or currently requiring Midodrine for blood pressure support 21. Subjects from, or who have traveled, to endemic areas with a history of active histoplasmosis or, with a chest x-ray consistent with previous active histoplasmosis (no serological testing required) : --Endemic regions determined by site based on local standard of care. 22. Subjects currently or formerly residing in regions of the United States that are highly endemic for coccidioidomycosis, and who have a positive serologic test for coccidioidomycosis: --Endemic regions determined by site based on local standard of care. 23. Recipients are excluded if the local site decides to treat the recipient with fluconazole because of diagnosis or suspicion of fungal infection the donor 24. Subjects that receive IVIG treatment within 3 months of transplant or planned intravenous immunoglobulin (IVIG) treatment peri-transplant 25. Use of an investigational agent within 4-weeks prior to study entry.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Difference Between the Mean eGFR (Modified MDRD) in the Experimental vs. Control Groups. | 24-Month post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the month 24 eGFR for each treatment group. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR). | 24 months post-transplantation | Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of greater than or equal to IA with or without clinical symptoms within 24 months of transplant were determined to have met the endpoint. Severity is graded as IA, IB, IIA, IIB, or III, with IA being the mildest form of cellular rejection and III being the most severe form of cellular rejection. Criteria include: IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation. |
| BANFF Grades of First Acute Cellular Rejections (ACR). | 6 month post-transplantation | Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of greater than or equal to IA with or without clinical symptoms within 6 months of transplant were determined to have met the endpoint. Severity is graded as IA, IB, IIA, IIB, or III, with IA being the mildest form of cellular rejection and III being the most severe form of cellular rejection.Criteria include: IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation. |
| Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection. | 6 months post-transplantation | Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of borderline or greater than or equal to IA with or without clinical symptoms within 6 months of transplant were determined to have met the endpoint. Severity is graded as Borderline, IA, IB, IIA, IIB, or III, with borderline representing possible cellular rejection, IA being the mildest form of cellular rejection, and III being the most severe form of cellular rejection.Criteria include: Borderline-no intimal arteritis is present but foci of mild tubulitis; IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation. |
| Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection | 24 months post-transplantation | Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of borderline or greater than or equal to IA with or without clinical symptoms within 24 months of transplant were determined to have met the endpoint. Severity is graded as Borderline, IA, IB, IIA, IIB, or III, with borderline representing possible cellular rejection, IA being the mildest form of cellular rejection, and III being the most severe form of cellular rejection. Criteria include: Borderline-no intimal arteritis is present but foci of mild tubulitis; IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation. |
| Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR) | 6 months post-transplantation | Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR within 6 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, or C4d staining positive.Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes. |
| Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR). | 24 months post-transplantation | Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR within 24 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, or C4d staining positive. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes. |
| Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR | 6 months post-transplantation | Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR or suspicious for AMR within 6 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, C4d staining positive, or suspicious. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes; suspicious-when 2 of 3 factors for acute/active are present. |
| Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR. | 24 months post-transplantation | Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR or suspicious for AMR within 24 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, C4d staining positive, or suspicious. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes; suspicious-when 2 of 3 factors for acute/active are present |
| BANFF Grades of First AMR. | 6 months post-transplantation | Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR within 6 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, or C4d staining positive. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes. |
| Percent of Participants With BANFF Chronicity Scores > or Equal 2 on the 24 Month Biopsy. | 24 months post-transplantation | The Banff 2013 classification involves scoring numerous characteristics of renal biopsy specimens. The ci (interstitial fibrosis) and ct (tubular atrophy) scores are two such characteristics. The scores can take values of 0, 1, 2, or 3 for each characteristic (ci and ct), indicating increasing severity of disease as the scores increase. Participants are considered to have met this endpoint if their ci + ct score on the 24 month biopsy summed to be \> or equal to 2. |
| Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 24 months post-transplantation | The Banff 2013 classification involves scoring numerous characteristics of renal biopsy specimens. The ci (interstitial fibrosis) and ct (tubular atrophy) scores are two such characteristics. The scores can take values of 0, 1, 2, or 3 for each characteristic (ci and ct), indicating increasing severity of disease as the scores increase. For this endpoint, the sum of ci+ct scores from the implantation biopsy was subtracted from the sum of the ci+ct scores from the month 24 biopsy and the difference between the two time points was classified as 0, 1, 2, or 3+. Higher values of this difference indicate more severe disease. |
| Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings. | 6 months post-transplantation | Biopsies were read by the local pathologist at the hospital where the participant was a patient. These local reads informed clinical care for the participant, which may or may not include prescribing/administering medication to the participant to help with clinical concerns or findings noted on a biopsy. Participants were considered to have met this endpoint if they have a report of receiving treatment for clinical or biopsy-proven rejection during the first 6 months post-transplant. |
| eGFR Values as Measured by MDRD | Day 7 post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from day 7 and months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the eGFR at each time point of interest for each treatment group. |
| Change in eGFR Between 3 Months and 24 Months as Measured by MDRD | 3 months and 24 months post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 3 and 24 was calculated as the month 24 eGFR minus the month 3 eGFR for each participant. A window of +/- 14 days was used for month 3 and +/- 1 month was used for month 24. |
| Change in eGFR Between 3 Months and 24 Months as Measured by CKD-EPI | 3 months and 24 months post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 3 and 24 was calculated as the month 24 eGFR minus the month 3 eGFR for each participant. A window of +/- 14 days was used for month 3 and +/- 1 month was used for month 24. |
| Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by MDRD | 6 months and 24 months post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. Post-transplant nadir was defined as the lowest value of eGFR from the first 6 months post-transplant. The change in eGFR between nadir and month 24 was calculated as the month 24 eGFR minus the nadir eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24. |
| Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by CKD-EPI | 6 months and 24 months post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. Post-transplant nadir was defined as the lowest value of eGFR from the first 6 months post-transplant. The change in eGFR between nadir and month 24 was calculated as the month 24 eGFR minus the nadir eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24. |
| Change in eGFR Between 6 Months and 24 Months as Measured by MDRD | 6 months and 24 months post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 6 and 24 was calculated as the month 24 eGFR minus the month 6 eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24. |
| Change in eGFR Between 6 Months and 24 Months as Measured by CKD-EPI | 6 months and 24 months post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 6 and 24 was calculated as the month 24 eGFR minus the month 6 eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24. |
| eGFR Values as Measured by CKD-EPI | Day 7 post-transplantation | Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from day 7 and months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the eGFR at each time point of interest for each treatment group. |
| Percent of Participants With Death or Graft Failure. | 24 months post-transplantation | Participants who died or experienced graft failure were considered to have met this endpoint. Graft failure was defined as the need for post-transplant dialysis for more than 56 days. |
| Percent of Participants With Only Graft Failure. | 24 months post-transplantation | Participants who experienced graft failure were considered to have met this endpoint. Graft failure was defined as the need for post-transplant dialysis for more than 56 days. |
| Percent of Participants That Required at Least One Dialysis Treatment. | 1 week post-transplantation | Dialysis within the first week post-transplant is used in the setting of delayed graft function (DGF). Participants are considered to have had DGF if they had at least one dialysis treatment in the first week post-transplant. |
| Number of Dialysis Sessions. | 8 weeks post-transplantation | The number of dialysis sessions a person had during their first 8 weeks post-transplant was used for this endpoint. |
| Duration of Delayed Graft Function (DGF), Defined as Time From Transplantation to the Last Required Dialysis Treatment. | First post-transplant dialysis treatment to last post-transplant dialysis treatment | Participants are considered to have had DGF if they had at least one dialysis treatment in the first week post-transplant. For this endpoint, duration was calculated as the date of last post-transplant dialysis treatment minus the date of the first post-transplant dialysis treatment. |
| Percent of Participants With Primary Non-Function (PNF), Defined as Dialysis-dependency for More Than 3 Months. | Transplantation through at least month 3 up to month 24 | Post-transplant dialysis is sometimes required in the setting of kidney transplant. If such dialysis continues for more than 3 months, the participant is considered to have PNF and, as such, meets this endpoint definition. |
| Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 24, 48 and 72 hours post-transplantation | Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. eGFR values from 24, 48, and 72 hours post-transplant (i.e., days 1, 2, and 3) were used to generate an estimate of the serum creatinine at each time point of interest for each treatment group. |
| Percent of Participants With CMV Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site | 24 months post-transplantation | Participants were considered to have met this endpoint if they had a reported case of CMV viremia that required a change in their existing immunosuppression or the use of anti-viral therapy. |
| Days From Transplantation Until Event (ACR, AMR, or Hospitalization for Infection and/or Malignancy) | 24 months post-transplantation | Participants are considered to have met this endpoint if they experienced biopsy-proven T-cell mediated rejection (ACR) or antibody mediated rejection (AMR) based on central pathology reading or were hospitalized for infection and/or malignancy. For participants who met one or more of these three components, the earliest event date of the three components was used as the time of meeting the endpoint. Participants who did not meet any of the three components were censored at their last date of follow-up. Event (or censor) day was calculated as event (or censor) date minus transplant date. |
| The Percent of Participants With a Serum Creatinine of More Than 3 mg/dL. | Day 5 post-transplantation | Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. This endpoint is ascertaining slow graft function in the immediate days post-transplant. A participant was considered to have met this endpoint if their day 5 serum creatinine was greater than 3 mg/dL. |
| Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 2 Divided by he First Creatinine After Surgery | Day 2 post-transplantation | Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 2 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function. |
| Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 5 Divided by the First Creatinine After Surgery. | Day 5 post-transplantation | Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 5 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function. |
| The Percent of Participants Whose Day 5 Serum CRR Was Less Than 70%. | Day 5 post-transplantation | Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 5 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function. A participant was considered to have met this endpoint if their day 5 serum CRR was less than 70%. |
| The Percent of Participants Whose Day 2 Serum CRR Was Less Than 30%. | Day 2 post-transplantation | Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 2 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function. A participant was considered to have met this endpoint if their day 2 serum CRR was less than 30%. |
| The Percent of Participants Who Need Dialysis After Week 1. | 1 week to 24 months post-transplantation | Participants who needed dialysis after the first week post-transplant were considered to have met this endpoint. |
| Percent of Participants With de Novo DSA. | 24 months post-transplantation | Donor specific antibody (DSA) can be formed post-transplant as part of the recipient's alloimmune response to the transplanted organ. DSA was determined by a central laboratory. Participants with newly developed DSA (i.e., de novo) following transplant were considered to have met this endpoint. |
| Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) | 6 month post-transplantation | Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of greater than or equal to IA with or without clinical symptoms within 6 months of transplant were determined to have met the endpoint. Severity is graded as IA, IB, IIA, IIB, or III, with IA being the mildest form of cellular rejection and III being the most severe form of cellular rejection.Criteria include: IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation. |
| Percent of Participants With Mycobacterial or Fungal Infections | 24 months post-transplantation | Participants were considered to have met this endpoint if they had at least one mycobacterial of fungal infection. |
| Percent of Participants With BK Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site. | 24 months post-transplantation | Participants were considered to have met this endpoint if they had a reported case of BK viremia that required a change in their existing immunosuppression or the use of anti-viral therapy. |
| Percent of Participants With Malignancy. | 24 months post-transplantation | Participants were considered to have met this endpoint if they had a reported case of malignancy. |
| Percent of Participants With Impaired Wound Healing Manifested by Wound Dehiscence, Wound Infection, or Hernia at the Site of the Transplant Incision | 24 months post-transplantation | Participants were considered to have met this endpoint if they had a reported case of impaired wound healing at the site of the transplant incision manifested by one wound dehiscence, wound infection, or hernia. |
| Percent of Participants With Any Infection Requiring Hospitalization or Resulting in Death. | 24 months post-transplantation | Participants were considered to have met this endpoint if they had an infection that required hospitalization or resulted in death. |
Countries
Canada, United States
Participant flow
Recruitment details
Fifteen sites consented 290 participants for evaluation of eligibility criteria. 242 participants were determined to be eligible and enrolled into this trial.
Pre-assignment details
290 potential participants signed an informed consent before undergoing any study procedures. After the informed consent was signed and the participant was determined to meet entry criteria, the participant was enrolled in the study. A total of 242 were determined eligible to start the study.
Participants by arm
| Arm | Count |
|---|---|
| Experimental The experimental group underwent a transplant procedure and received rabbit anti-thymocyte globulin (rATG, Thymoglobulin) co-administered with anti-TNFa (infliximab/Remicade®) followed by maintenance therapy with tacrolimus, either Mycophenolate Mofetil/MMF or Mycophenolate Acid/MPA (or their generic equivalents) and prednisone | 113 |
| Control The control group underwent a transplant procedure and received rabbit anti-thymocyte globulin (rATG, Thymoglobulin) plus placebo (sterile normal saline) induction followed by maintenance therapy with tacrolimus, either Mycophenolate Mofetil/MMF or Mycophenolate Acid/MPA (or their generic equivalents) and prednisone | 112 |
| Total | 225 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 0 | 1 | 1 | 0 |
| Overall Study | Covid-19 research restrictions | 1 | 0 | 0 | 0 |
| Overall Study | Death | 3 | 5 | 0 | 0 |
| Overall Study | Incarcerated | 0 | 1 | 0 | 0 |
| Overall Study | Lost to Follow-up | 6 | 4 | 0 | 0 |
| Overall Study | Physician Decision | 2 | 1 | 4 | 0 |
| Overall Study | Protocol Violation | 0 | 1 | 0 | 0 |
| Overall Study | Screen Failure | 0 | 0 | 0 | 48 |
| Overall Study | Timing of transplant and randomization | 0 | 0 | 5 | 0 |
| Overall Study | Transplant nephrectomy, patient decision | 0 | 1 | 0 | 0 |
| Overall Study | Visit 14 scheduling difficulties | 1 | 0 | 0 | 0 |
| Overall Study | Withdrawal by Subject | 7 | 7 | 7 | 0 |
Baseline characteristics
| Characteristic | Experimental | Control | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 20 Participants | 16 Participants | 36 Participants |
| Age, Categorical Between 18 and 65 years | 93 Participants | 96 Participants | 189 Participants |
| Age, Continuous | 53.2 years STANDARD_DEVIATION 10.7 | 53.6 years STANDARD_DEVIATION 10.69 | 53.4 years STANDARD_DEVIATION 10.67 |
| Donor Cause of Death CVA | 34 Participants | 22 Participants | 56 Participants |
| Donor Cause of Death Non-CVA | 79 Participants | 90 Participants | 169 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 17 Participants | 12 Participants | 29 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 96 Participants | 99 Participants | 195 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 7 Participants | 6 Participants | 13 Participants |
| Race (NIH/OMB) Black or African American | 40 Participants | 46 Participants | 86 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 12 Participants | 9 Participants | 21 Participants |
| Race (NIH/OMB) White | 51 Participants | 48 Participants | 99 Participants |
| Reason for Transplant Diabetes | 28 Participants | 32 Participants | 60 Participants |
| Reason for Transplant Glomerular disease | 21 Participants | 18 Participants | 39 Participants |
| Reason for Transplant Hypertension | 24 Participants | 23 Participants | 47 Participants |
| Reason for Transplant Other | 25 Participants | 29 Participants | 54 Participants |
| Reason for Transplant Polycystic kidney disease | 15 Participants | 10 Participants | 25 Participants |
| Region of Enrollment Canada | 2 participants | 2 participants | 4 participants |
| Region of Enrollment United States | 111 participants | 110 participants | 221 participants |
| Sex: Female, Male Female | 42 Participants | 48 Participants | 90 Participants |
| Sex: Female, Male Male | 71 Participants | 64 Participants | 135 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 3 / 114 | 5 / 112 |
| other Total, other adverse events | 44 / 114 | 41 / 112 |
| serious Total, serious adverse events | 87 / 114 | 82 / 112 |
Outcome results
The Difference Between the Mean eGFR (Modified MDRD) in the Experimental vs. Control Groups.
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the month 24 eGFR for each treatment group.
Time frame: 24-Month post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Experimental | The Difference Between the Mean eGFR (Modified MDRD) in the Experimental vs. Control Groups. | 52.45 mL/min/1.73m2 |
| Control | The Difference Between the Mean eGFR (Modified MDRD) in the Experimental vs. Control Groups. | 57.35 mL/min/1.73m2 |
BANFF Grades of First Acute Cellular Rejections (ACR).
Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of greater than or equal to IA with or without clinical symptoms within 6 months of transplant were determined to have met the endpoint. Severity is graded as IA, IB, IIA, IIB, or III, with IA being the mildest form of cellular rejection and III being the most severe form of cellular rejection.Criteria include: IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.
Time frame: 6 month post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who had ACR within the first 6 months.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Experimental | BANFF Grades of First Acute Cellular Rejections (ACR). | IB | 1 Participants |
| Experimental | BANFF Grades of First Acute Cellular Rejections (ACR). | IIB | 0 Participants |
| Experimental | BANFF Grades of First Acute Cellular Rejections (ACR). | IIA | 1 Participants |
| Experimental | BANFF Grades of First Acute Cellular Rejections (ACR). | III | 0 Participants |
| Experimental | BANFF Grades of First Acute Cellular Rejections (ACR). | IA | 1 Participants |
| Control | BANFF Grades of First Acute Cellular Rejections (ACR). | III | 0 Participants |
| Control | BANFF Grades of First Acute Cellular Rejections (ACR). | IA | 1 Participants |
| Control | BANFF Grades of First Acute Cellular Rejections (ACR). | IB | 0 Participants |
| Control | BANFF Grades of First Acute Cellular Rejections (ACR). | IIA | 1 Participants |
| Control | BANFF Grades of First Acute Cellular Rejections (ACR). | IIB | 0 Participants |
BANFF Grades of First AMR.
Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR within 6 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, or C4d staining positive. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes.
Time frame: 6 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Experimental | BANFF Grades of First AMR. | 0 Participants |
| Control | BANFF Grades of First AMR. | 0 Participants |
Change From Baseline (Immediately After Surgery) in Serum Creatinine.
Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. eGFR values from 24, 48, and 72 hours post-transplant (i.e., days 1, 2, and 3) were used to generate an estimate of the serum creatinine at each time point of interest for each treatment group.
Time frame: 24, 48 and 72 hours post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available serum creatinine data during the first 72 hours post-transplant.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Experimental | Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 24 Hours | 7.35 mg/dL |
| Experimental | Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 48 Hours | 6.24 mg/dL |
| Experimental | Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 72 Hours | 5.77 mg/dL |
| Control | Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 24 Hours | 6.85 mg/dL |
| Control | Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 48 Hours | 5.87 mg/dL |
| Control | Change From Baseline (Immediately After Surgery) in Serum Creatinine. | 72 Hours | 5.21 mg/dL |
Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy.
The Banff 2013 classification involves scoring numerous characteristics of renal biopsy specimens. The ci (interstitial fibrosis) and ct (tubular atrophy) scores are two such characteristics. The scores can take values of 0, 1, 2, or 3 for each characteristic (ci and ct), indicating increasing severity of disease as the scores increase. For this endpoint, the sum of ci+ct scores from the implantation biopsy was subtracted from the sum of the ci+ct scores from the month 24 biopsy and the difference between the two time points was classified as 0, 1, 2, or 3+. Higher values of this difference indicate more severe disease.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available ci and ct scores from central pathology on both the implantation and 24 month biopsy.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Experimental | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 0 | 4 Participants |
| Experimental | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 1 | 6 Participants |
| Experimental | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 2 | 9 Participants |
| Experimental | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 3+ | 7 Participants |
| Control | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 3+ | 4 Participants |
| Control | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 0 | 6 Participants |
| Control | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 2 | 2 Participants |
| Control | Change in BANFF Chronicity Scores Between Implantation and the 24 Month Biopsy. | 1 | 6 Participants |
Change in eGFR Between 3 Months and 24 Months as Measured by CKD-EPI
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 3 and 24 was calculated as the month 24 eGFR minus the month 3 eGFR for each participant. A window of +/- 14 days was used for month 3 and +/- 1 month was used for month 24.
Time frame: 3 months and 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data within window at months 3 and 24.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Change in eGFR Between 3 Months and 24 Months as Measured by CKD-EPI | 2.7 mL/min/1.73m2 | Standard Deviation 16.38 |
| Control | Change in eGFR Between 3 Months and 24 Months as Measured by CKD-EPI | 4.4 mL/min/1.73m2 | Standard Deviation 13.91 |
Change in eGFR Between 3 Months and 24 Months as Measured by MDRD
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 3 and 24 was calculated as the month 24 eGFR minus the month 3 eGFR for each participant. A window of +/- 14 days was used for month 3 and +/- 1 month was used for month 24.
Time frame: 3 months and 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data within window at months 3 and 24.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Change in eGFR Between 3 Months and 24 Months as Measured by MDRD | 2.8 mL/min/1.73m2 | Standard Deviation 15.06 |
| Control | Change in eGFR Between 3 Months and 24 Months as Measured by MDRD | 4.8 mL/min/1.73m2 | Standard Deviation 13.26 |
Change in eGFR Between 6 Months and 24 Months as Measured by CKD-EPI
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 6 and 24 was calculated as the month 24 eGFR minus the month 6 eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24.
Time frame: 6 months and 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data within window at months 6 and 24.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Change in eGFR Between 6 Months and 24 Months as Measured by CKD-EPI | 0.8 mL/min/1.73m2 | Standard Deviation 12.67 |
| Control | Change in eGFR Between 6 Months and 24 Months as Measured by CKD-EPI | 4.8 mL/min/1.73m2 | Standard Deviation 13.42 |
Change in eGFR Between 6 Months and 24 Months as Measured by MDRD
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. The change in eGFR between months 6 and 24 was calculated as the month 24 eGFR minus the month 6 eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24.
Time frame: 6 months and 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data within window at months 6 and 24.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Change in eGFR Between 6 Months and 24 Months as Measured by MDRD | 1.0 mL/min/1.73m2 | Standard Deviation 11.73 |
| Control | Change in eGFR Between 6 Months and 24 Months as Measured by MDRD | 5.2 mL/min/1.73m2 | Standard Deviation 13.05 |
Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by CKD-EPI
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. Post-transplant nadir was defined as the lowest value of eGFR from the first 6 months post-transplant. The change in eGFR between nadir and month 24 was calculated as the month 24 eGFR minus the nadir eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24.
Time frame: 6 months and 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data within window at months 6 and 24.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by CKD-EPI | 8.5 mL/min/1.73m2 | Standard Deviation 15.21 |
| Control | Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by CKD-EPI | 12.0 mL/min/1.73m2 | Standard Deviation 15.36 |
Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by MDRD
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. Post-transplant nadir was defined as the lowest value of eGFR from the first 6 months post-transplant. The change in eGFR between nadir and month 24 was calculated as the month 24 eGFR minus the nadir eGFR for each participant. A window of +/- 21 days was used for month 6 and +/- 1 month was used for month 24.
Time frame: 6 months and 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data within window at months 6 and 24.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by MDRD | 8.1 mL/min/1.73m2 | Standard Deviation 14.06 |
| Control | Change in eGFR Between Post-transplant Nadir and 24 Months as Measured by MDRD | 11.6 mL/min/1.73m2 | Standard Deviation 14.69 |
Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 2 Divided by he First Creatinine After Surgery
Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 2 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function.
Time frame: Day 2 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who did not experience delayed graft function and with available serum creatinine data on days 1 and 2 post-transplant.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 2 Divided by he First Creatinine After Surgery | 24.28 Percentage | Standard Deviation 22.6 |
| Control | Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 2 Divided by he First Creatinine After Surgery | 20.97 Percentage | Standard Deviation 16.64 |
Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 5 Divided by the First Creatinine After Surgery.
Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 5 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function.
Time frame: Day 5 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who did not experience delayed graft function and with available serum creatinine data on days 1 and 5 post-transplant.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 5 Divided by the First Creatinine After Surgery. | 47.06 Percentage | Standard Deviation 28.86 |
| Control | Creatinine Reduction Ratio (CRR), Defined as the First Creatinine on Day 5 Divided by the First Creatinine After Surgery. | 43.37 Percentage | Standard Deviation 25.79 |
Days From Transplantation Until Event (ACR, AMR, or Hospitalization for Infection and/or Malignancy)
Participants are considered to have met this endpoint if they experienced biopsy-proven T-cell mediated rejection (ACR) or antibody mediated rejection (AMR) based on central pathology reading or were hospitalized for infection and/or malignancy. For participants who met one or more of these three components, the earliest event date of the three components was used as the time of meeting the endpoint. Participants who did not meet any of the three components were censored at their last date of follow-up. Event (or censor) day was calculated as event (or censor) date minus transplant date.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology data and hospitalization data.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Experimental | Days From Transplantation Until Event (ACR, AMR, or Hospitalization for Infection and/or Malignancy) | 642 Days to event |
| Control | Days From Transplantation Until Event (ACR, AMR, or Hospitalization for Infection and/or Malignancy) | 613 Days to event |
Duration of Delayed Graft Function (DGF), Defined as Time From Transplantation to the Last Required Dialysis Treatment.
Participants are considered to have had DGF if they had at least one dialysis treatment in the first week post-transplant. For this endpoint, duration was calculated as the date of last post-transplant dialysis treatment minus the date of the first post-transplant dialysis treatment.
Time frame: First post-transplant dialysis treatment to last post-transplant dialysis treatment
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Duration of Delayed Graft Function (DGF), Defined as Time From Transplantation to the Last Required Dialysis Treatment. | 13.27 Days | Standard Deviation 13.89 |
| Control | Duration of Delayed Graft Function (DGF), Defined as Time From Transplantation to the Last Required Dialysis Treatment. | 15.74 Days | Standard Deviation 38.37 |
eGFR Values as Measured by CKD-EPI
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from day 7 and months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the eGFR at each time point of interest for each treatment group.
Time frame: Days 30, 90, and 180 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Experimental | eGFR Values as Measured by CKD-EPI | Day 30 | 49.29 mL/min/1.73m2 |
| Experimental | eGFR Values as Measured by CKD-EPI | Day 90 | 49.80 mL/min/1.73m2 |
| Experimental | eGFR Values as Measured by CKD-EPI | Day 180 | 50.56 mL/min/1.73m2 |
| Control | eGFR Values as Measured by CKD-EPI | Day 30 | 50.63 mL/min/1.73m2 |
| Control | eGFR Values as Measured by CKD-EPI | Day 90 | 51.44 mL/min/1.73m2 |
| Control | eGFR Values as Measured by CKD-EPI | Day 180 | 52.65 mL/min/1.73m2 |
eGFR Values as Measured by CKD-EPI
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from day 7 and months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the eGFR at each time point of interest for each treatment group.
Time frame: Day 7 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Experimental | eGFR Values as Measured by CKD-EPI | 41.01 mL/min/1.73m2 |
| Control | eGFR Values as Measured by CKD-EPI | 41.85 mL/min/1.73m2 |
eGFR Values as Measured by MDRD
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from day 7 and months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the eGFR at each time point of interest for each treatment group.
Time frame: Days 30, 60, and 180 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Experimental | eGFR Values as Measured by MDRD | Day 30 | 46.64 mL/min/1.73m2 |
| Experimental | eGFR Values as Measured by MDRD | Day 90 | 47.14 mL/min/1.73m2 |
| Experimental | eGFR Values as Measured by MDRD | Day 180 | 47.89 mL/min/1.73m2 |
| Control | eGFR Values as Measured by MDRD | Day 30 | 48.20 mL/min/1.73m2 |
| Control | eGFR Values as Measured by MDRD | Day 90 | 48.99 mL/min/1.73m2 |
| Control | eGFR Values as Measured by MDRD | Day 180 | 50.16 mL/min/1.73m2 |
eGFR Values as Measured by MDRD
Glomerular filtration rate (GFR) is a measure of kidney function and helps determine the stage of kidney disease. eGFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. A value of 90+ means kidney function is normal. A value between 60 and 89 indicates mildly reduced kidney function, pointing to kidney disease. Values between 30 and 59 indicates moderately reduced kidney function. Values between 15 and 29 indicate severely reduced kidney function. Values below 15 indicate very severe or endstage kidney failure. eGFR values from day 7 and months 1, 3, 6, 12, 18, and 24 were used to generate an estimate of the eGFR at each time point of interest for each treatment group.
Time frame: Day 7 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available eGFR data.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Experimental | eGFR Values as Measured by MDRD | 38.93 mL/min/1.73m2 |
| Control | eGFR Values as Measured by MDRD | 39.96 mL/min/1.73m2 |
Number of Dialysis Sessions.
The number of dialysis sessions a person had during their first 8 weeks post-transplant was used for this endpoint.
Time frame: 8 weeks post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available data during the first 8 weeks.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental | Number of Dialysis Sessions. | 0.14 Dialysis sessions | Standard Deviation 1 |
| Control | Number of Dialysis Sessions. | 0.26 Dialysis sessions | Standard Deviation 2.32 |
Percent of Participants That Required at Least One Dialysis Treatment.
Dialysis within the first week post-transplant is used in the setting of delayed graft function (DGF). Participants are considered to have had DGF if they had at least one dialysis treatment in the first week post-transplant.
Time frame: 1 week post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants That Required at Least One Dialysis Treatment. | 31.0 percentage of participants |
| Control | Percent of Participants That Required at Least One Dialysis Treatment. | 35.7 percentage of participants |
Percent of Participants With Any Infection Requiring Hospitalization or Resulting in Death.
Participants were considered to have met this endpoint if they had an infection that required hospitalization or resulted in death.
Time frame: 24 months post-transplantation
Population: Safety population included all participants who received at least a portion of the infliximab/placebo infusion. This population includes one participant in the Experimental group who received some of the infliximab infusion prior to the transplant procedure being aborted.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Any Infection Requiring Hospitalization or Resulting in Death. | 43.0 percentage of participants |
| Control | Percent of Participants With Any Infection Requiring Hospitalization or Resulting in Death. | 39.3 percentage of participants |
Percent of Participants With BANFF Chronicity Scores > or Equal 2 on the 24 Month Biopsy.
The Banff 2013 classification involves scoring numerous characteristics of renal biopsy specimens. The ci (interstitial fibrosis) and ct (tubular atrophy) scores are two such characteristics. The scores can take values of 0, 1, 2, or 3 for each characteristic (ci and ct), indicating increasing severity of disease as the scores increase. Participants are considered to have met this endpoint if their ci + ct score on the 24 month biopsy summed to be \> or equal to 2.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available 24 month central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With BANFF Chronicity Scores > or Equal 2 on the 24 Month Biopsy. | 73.1 percentage of participants |
| Control | Percent of Participants With BANFF Chronicity Scores > or Equal 2 on the 24 Month Biopsy. | 36.4 percentage of participants |
Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR)
Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR within 6 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, or C4d staining positive.Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes.
Time frame: 6 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR) | 0.0 Participants |
| Control | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR) | 0.0 Participants |
Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR).
Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR within 24 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, or C4d staining positive. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR). | 1.3 percentage of participant |
| Control | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection (AMR). | 0.0 percentage of participant |
Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR
Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR or suspicious for AMR within 6 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, C4d staining positive, or suspicious. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes; suspicious-when 2 of 3 factors for acute/active are present.
Time frame: 6 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR | 2.8 percentage of participants |
| Control | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR | 0.0 percentage of participants |
Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR.
Antibody mediated rejection (AMR) was defined based on central lab pathology interpretation using the Banff 2013 criteria. Participants with a Banff finding of AMR or suspicious for AMR within 24 months of transplant were determined to have met the endpoint. AMR is classified as acute/active, chronic/active, C4d staining positive, or suspicious. Criteria include: acute/active-histologic evidence of acute tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of donor-specific antibodies (DSAs); chronic/active-morphologic evidence of chronic tissue injury, evidence of current/recent antibody interaction with vascular endothelium, and serologic evidence of DSAs; C4d staining positive-linear C4d staining in peritubular capillaries, glomerulitis=0, peritubular capillary=0, chronic glomerulopathy=0, no acute cell-mediated rejection or borderline changes; suspicious-when 2 of 3 factors for acute/active are present
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR. | 3.8 percentage of participants |
| Control | Percent of Participants With Biopsy Proven Acute Antibody Mediated Rejection AMR or Suspicious for AMR. | 1.4 percentage of participants |
Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR)
Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of greater than or equal to IA with or without clinical symptoms within 6 months of transplant were determined to have met the endpoint. Severity is graded as IA, IB, IIA, IIB, or III, with IA being the mildest form of cellular rejection and III being the most severe form of cellular rejection.Criteria include: IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.
Time frame: 6 month post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) | 4.2 percentage of participants |
| Control | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) | 3.0 percentage of participants |
Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR).
Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of greater than or equal to IA with or without clinical symptoms within 24 months of transplant were determined to have met the endpoint. Severity is graded as IA, IB, IIA, IIB, or III, with IA being the mildest form of cellular rejection and III being the most severe form of cellular rejection. Criteria include: IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR). | 5.1 percentage of participants |
| Control | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR). | 4.2 percentage of participants |
Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection
Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of borderline or greater than or equal to IA with or without clinical symptoms within 24 months of transplant were determined to have met the endpoint. Severity is graded as Borderline, IA, IB, IIA, IIB, or III, with borderline representing possible cellular rejection, IA being the mildest form of cellular rejection, and III being the most severe form of cellular rejection. Criteria include: Borderline-no intimal arteritis is present but foci of mild tubulitis; IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.
Time frame: 24 months post-transplantation
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection | 12.8 percentage of participants |
| Control | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection | 7 percentage of participants |
Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection.
Acute cellular rejection was defined based on central lab pathology interpretation using the Banff 2007 criteria. Participants with a Banff grade of borderline or greater than or equal to IA with or without clinical symptoms within 6 months of transplant were determined to have met the endpoint. Severity is graded as Borderline, IA, IB, IIA, IIB, or III, with borderline representing possible cellular rejection, IA being the mildest form of cellular rejection, and III being the most severe form of cellular rejection.Criteria include: Borderline-no intimal arteritis is present but foci of mild tubulitis; IA-significant interstitial infiltration and foci of moderate tubulitis; IB-significant interstitial infiltration and foci of severe tubulitis; IIA-mild to moderate intimal arteritis; IIB-severe intimal arteritis; III-transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.
Time frame: 6 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available central pathology read data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection. | 8.5 percentage of participants |
| Control | Percent of Participants With Biopsy Proven Acute Cellular Rejection (BPAR) or Borderline Rejection. | 6.1 percentage of participants |
Percent of Participants With BK Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site.
Participants were considered to have met this endpoint if they had a reported case of BK viremia that required a change in their existing immunosuppression or the use of anti-viral therapy.
Time frame: 24 months post-transplantation
Population: Safety population included all participants who received at least a portion of the infliximab/placebo infusion. This population includes one participant in the Experimental group who received some of the infliximab infusion prior to the transplant procedure being aborted.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With BK Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site. | 28.9 Percent of participants |
| Control | Percent of Participants With BK Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site. | 13.4 Percent of participants |
Percent of Participants With CMV Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site
Participants were considered to have met this endpoint if they had a reported case of CMV viremia that required a change in their existing immunosuppression or the use of anti-viral therapy.
Time frame: 24 months post-transplantation
Population: Safety population included all participants who received at least a portion of the infliximab/placebo infusion. This population includes one participant in the Experimental group who received some of the infliximab infusion prior to the transplant procedure being aborted.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With CMV Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site | 18.4 percentage of participants |
| Control | Percent of Participants With CMV Viremia That Require a Change in Immunosuppression or Anti-viral Treatment as Per Standard of Care at the Site | 11.6 percentage of participants |
Percent of Participants With Death or Graft Failure.
Participants who died or experienced graft failure were considered to have met this endpoint. Graft failure was defined as the need for post-transplant dialysis for more than 56 days.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Death or Graft Failure. | 5.3 percentage of participants |
| Control | Percent of Participants With Death or Graft Failure. | 7.1 percentage of participants |
Percent of Participants With de Novo DSA.
Donor specific antibody (DSA) can be formed post-transplant as part of the recipient's alloimmune response to the transplanted organ. DSA was determined by a central laboratory. Participants with newly developed DSA (i.e., de novo) following transplant were considered to have met this endpoint.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who had available DSA data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With de Novo DSA. | 8.0 percentage of participants |
| Control | Percent of Participants With de Novo DSA. | 3.6 percentage of participants |
Percent of Participants With Impaired Wound Healing Manifested by Wound Dehiscence, Wound Infection, or Hernia at the Site of the Transplant Incision
Participants were considered to have met this endpoint if they had a reported case of impaired wound healing at the site of the transplant incision manifested by one wound dehiscence, wound infection, or hernia.
Time frame: 24 months post-transplantation
Population: Safety population included all participants who received at least a portion of the infliximab/placebo infusion. This population includes one participant in the Experimental group who received some of the infliximab infusion prior to the transplant procedure being aborted.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Impaired Wound Healing Manifested by Wound Dehiscence, Wound Infection, or Hernia at the Site of the Transplant Incision | 7.9 Percent of participants |
| Control | Percent of Participants With Impaired Wound Healing Manifested by Wound Dehiscence, Wound Infection, or Hernia at the Site of the Transplant Incision | 11.6 Percent of participants |
Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings.
Biopsies were read by the local pathologist at the hospital where the participant was a patient. These local reads informed clinical care for the participant, which may or may not include prescribing/administering medication to the participant to help with clinical concerns or findings noted on a biopsy. Participants were considered to have met this endpoint if they have a report of receiving treatment for clinical or biopsy-proven rejection during the 24 month post-transplant follow-up.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available local pathology read data during the 24 month post-transplant follow-up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings. | 16.2 percentage of participants |
| Control | Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings. | 27 percentage of participants |
Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings.
Biopsies were read by the local pathologist at the hospital where the participant was a patient. These local reads informed clinical care for the participant, which may or may not include prescribing/administering medication to the participant to help with clinical concerns or findings noted on a biopsy. Participants were considered to have met this endpoint if they have a report of receiving treatment for clinical or biopsy-proven rejection during the first 6 months post-transplant.
Time frame: 6 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available local pathology read data during the first 6 months of post-transplant follow-up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings. | 12.6 percentage of participants |
| Control | Percent of Participants With Locally Treated Rejection, Defined as Treatment Administered for Rejection Based on Clinical Signs or Biopsy Findings. | 20.5 percentage of participants |
Percent of Participants With Malignancy.
Participants were considered to have met this endpoint if they had a reported case of malignancy.
Time frame: 24 months post-transplantation
Population: Safety population included all participants who received at least a portion of the infliximab/placebo infusion. This population includes one participant in the Experimental group who received some of the infliximab infusion prior to the transplant procedure being aborted.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Malignancy. | 1.8 Percent of Participants |
| Control | Percent of Participants With Malignancy. | 0.9 Percent of Participants |
Percent of Participants With Mycobacterial or Fungal Infections
Participants were considered to have met this endpoint if they had at least one mycobacterial of fungal infection.
Time frame: 24 months post-transplantation
Population: Safety population included all participants who received at least a portion of the infliximab/placebo infusion. This population includes one participant in the Experimental group who received some of the infliximab infusion prior to the transplant procedure being aborted.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Mycobacterial or Fungal Infections | 6.1 percentage of participants |
| Control | Percent of Participants With Mycobacterial or Fungal Infections | 6.3 percentage of participants |
Percent of Participants With Only Graft Failure.
Participants who experienced graft failure were considered to have met this endpoint. Graft failure was defined as the need for post-transplant dialysis for more than 56 days.
Time frame: 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Only Graft Failure. | 2.7 percentage of participants |
| Control | Percent of Participants With Only Graft Failure. | 2.7 percentage of participants |
Percent of Participants With Primary Non-Function (PNF), Defined as Dialysis-dependency for More Than 3 Months.
Post-transplant dialysis is sometimes required in the setting of kidney transplant. If such dialysis continues for more than 3 months, the participant is considered to have PNF and, as such, meets this endpoint definition.
Time frame: Transplantation through at least month 3 up to month 24
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants with available data for dialysis used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | Percent of Participants With Primary Non-Function (PNF), Defined as Dialysis-dependency for More Than 3 Months. | 2.8 Percent of Participants |
| Control | Percent of Participants With Primary Non-Function (PNF), Defined as Dialysis-dependency for More Than 3 Months. | 0.9 Percent of Participants |
The Percent of Participants Who Need Dialysis After Week 1.
Participants who needed dialysis after the first week post-transplant were considered to have met this endpoint.
Time frame: 1 week to 24 months post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who did not experience delayed graft function and with available data after week 1.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | The Percent of Participants Who Need Dialysis After Week 1. | 9.0 percentage of participants |
| Control | The Percent of Participants Who Need Dialysis After Week 1. | 2.8 percentage of participants |
The Percent of Participants Whose Day 2 Serum CRR Was Less Than 30%.
Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 2 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function. A participant was considered to have met this endpoint if their day 2 serum CRR was less than 30%.
Time frame: Day 2 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who did not experience delayed graft function and with available serum creatinine data on days 1 and 2 post-transplant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | The Percent of Participants Whose Day 2 Serum CRR Was Less Than 30%. | 57.1 percentage of participants |
| Control | The Percent of Participants Whose Day 2 Serum CRR Was Less Than 30%. | 68.6 percentage of participants |
The Percent of Participants Whose Day 5 Serum CRR Was Less Than 70%.
Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. CRR was calculated as the day 1 post-transplant creatinine value minus the day 5 creatinine value divided by the day 1 creatinine value and multiplied by 100, resulting in a percentage. Higher numbers indicate a greater reduction in serum creatinine and, thus, potentially better kidney function. A participant was considered to have met this endpoint if their day 5 serum CRR was less than 70%.
Time frame: Day 5 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who did not experience delayed graft function and with available serum creatinine data on days 1 and 5 post-transplant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | The Percent of Participants Whose Day 5 Serum CRR Was Less Than 70%. | 74.4 percentage of participants |
| Control | The Percent of Participants Whose Day 5 Serum CRR Was Less Than 70%. | 88.4 percentage of participants |
The Percent of Participants With a Serum Creatinine of More Than 3 mg/dL.
Serum creatinine (mg/dL) is used to measure kidney function. A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Higher results indicate poorer kidney function, as creatinine is removed from the body by the kidneys. This endpoint is ascertaining slow graft function in the immediate days post-transplant. A participant was considered to have met this endpoint if their day 5 serum creatinine was greater than 3 mg/dL.
Time frame: Day 5 post-transplantation
Population: Intent-to-treat population included all transplanted and randomized participants who received the infliximab/placebo infusion, subset to participants who did not experience delayed graft function and with available serum creatinine data at day 5 post-transplant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental | The Percent of Participants With a Serum Creatinine of More Than 3 mg/dL. | 47.4 percentage of participants |
| Control | The Percent of Participants With a Serum Creatinine of More Than 3 mg/dL. | 42.9 percentage of participants |