Kidney Transplant, Kidney Transplant Rejection
Conditions
Keywords
transplant, kidney, Microbiome
Brief summary
The purpose of this research is to study immunosuppression drugs, certain foods, and how they can change the microbiome (the natural microorganisms inside the body) of the individual taking the immunosuppressive medications. The study team wants to study how the microbiome affects how the body processes the transplant medication.
Detailed description
Immunosuppression drugs, like antibiotics and certain foods, can change the microbiome (the natural micro-organisms inside the body) of the individual taking the drug. The study team wants to study what impact these changes to the microbiome have on the individual. The study team is specifically interested in how these changes to the microbiome may change the metabolism (breakdown) and action of medications. It is already known that individual genetics impact the metabolism, absorption, and toxicities of some medications. It is suspected that the microbiome will have similar impacts on medications. With a better understanding of how individual microbiome impacts immunosuppressant medications used to help transplant recipients from rejecting their new organs, providers can more accurately prescribe and dose these medications to better treat and care for transplant patients and their organs. It is expected that participants will be in this research study for up to 12 years. There will be periods of time that requires active participation (visits) and periods of time that will be more passive participation (allowing study staff to follow-up with medical records for outcomes).
Interventions
OTHERcollection of body microbiome
A prospective, observational microbiome study of adult kidney transplant recipients receiving mycophenolate mofetil and tacrolimus maintenance immunosuppression. Participants will be studied post-transplant for mycophenolate pharmacokinetics and microbiome samples collected. Clinically measured tacrolimus trough concentrations will also be evaluated. Associations among mycophenolic acid enterohepatic recycling and metabolite formation, tacrolimus troughs, immunosuppression adverse effects, diarrhea and microbiome will be studied.
Sponsors
The University of Texas Medical Branch, Galveston
National Institute of Allergy and Infectious Diseases (NIAID)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participants undergoing kidney transplant * Male or female at least 18 years of age at time of enrollment * Will or have received a living or deceased donor kidney transplant * Planned post-transplant immunosuppression regimen of mycophenolate mofetil dosed every 12 hours (Cellcept or generic) and immediate release tacrolimus dosed twice daily with trough concentration monitoring (generic or brand formulation). * Able and willing to complete study-related procedures and visits * Signs written informed consent
Exclusion criteria
* Recipient of a previous non-kidney transplant * Subject is a multi-organ transplant recipient * Presence of active gastroparesis, and documented in the medical record * Liver dysfunction (total bilirubin \>2x upper limit of normal) within 2 months of enrollment * Patients who take medications that significantly inhibit uridine 5'-diphosphate glucuronosyltransferase (UGT) enzymes. * Patients who take medications that significantly inhibit or induce the biliary transporters * Patient is known to be HIV positive * Pregnant or nursing (lactating) women * Non-English speaking * Patients who have undergone bariatric surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To assess the relationship between transplant graft outcomes and urinary transcriptome. | 5 years | The gut microbiome has been implicated in the Stool from tx recipients with diarrhea is often sent for testing of potential pathogenic organisms. polymerase chain reaction (PCR)- based approaches to identify etiology of post-tx diarrhea only tests for a limited number of organisms. |
| To assess the relationship between kidney graft outcomes and stool, oral, nasal, and urine microbiome diversity. | 5 years | The gut microbiome has been implicated in the variability in metabolism of drugs with specific microbial species being associated with direct and indirect effects. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAjay Israni, MD
University of Texas Medical Branch, Galveston
Outcome results
None listed