Study Evaluating A Planned Transition From Tacrolimus To Sirolimus In Kidney Transplant Recipients
Condition: Graft Rejection; Kidney Transplant; Renal Allograft Recipients; Renal Transplant
Intervention: Tacrolimus; Sirolimus; Tacrolimus
Intervention description: During the screening phase, tacrolimus is provided by the investigator (not the Sponsor) and is dosed to achieve a target trough level determined by the investigator. Therefore, the dosage form, dosage, and frequency are determined by the investigator. Duration of treatment is from transplantation until randomization (from 90 to 150 days).; Following randomization, sirolimus is provided by the Sponsor in 1 and 2 mg oral tablets. Sirolimus is dosed once daily to achieve a target trough level of 7 to 15 ng/mL in the 1st year post-transplant and 5 - 15 ng/mL in the 2nd year post-transplant. Duration of treatment is from randomization through 2 years post-transplant (19 to 21 months).; During the study, tacrolimus is provided by the investigator (not the Sponsor) and is dosed to achieve a target trough level determined by the investigator. Therefore, the dosage form, dosage, and frequency are determined by the investigator. Duration of treatment is 2 years post-transplant.
Intervention MeSH terms: Sirolimus; Tacrolimus
Phase: Phase 4
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 254.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: renal transplant; immunosuppression; sirolimus/rapamune; planned transition

Summary:

      This study will look at the effect on long-term kidney function using tacrolimus right after
      a transplant and then switching to sirolimus at 3 to 5 months after the transplant.
    

Eligibility criteria:

        Inclusion Criteria:

        At Screening:

          -  Male or female subjects aged 18 years or older.

          -  Recipients who are 14 days prior to transplantation up through 14 days after
             transplantation.

          -  Recipients of a primary, living- or deceased-donor renal allograft.

          -  All female and male subjects who are biologically capable of having children must
             agree and commit to the use of a reliable method of birth control for the duration of
             the study and for 3 months after the last dose of test article. A subject is
             biologically capable of having children even if he or she is using contraceptives or
             if his or her sexual partner is sterile or using contraceptives.

        At Randomization:

          -  Ninety (90) to 150 days post-transplantation.

          -  Treatment with tacrolimus and an inosine monophosphate dehydrogenase (IMPDH) inhibitor
             initiated less than or equal to 30 days of transplantation and has remained on both
             for the 30 days prior to randomization.

        Exclusion Criteria:

        At Screening:

          -  Recipients of multiple organ transplants (i.e., any prior or concurrent
             transplantation of any organs including prior renal transplant. )

          -  Recipients of adult or pediatric en bloc kidney transplants.

          -  Recipients who required or will require desensitization protocols.

          -  Known history of focal segmental glomerulosclerosis (FSGS) or membranoproliferative
             glomerulonephritis (MPGN).

          -  Evidence of active systemic or localized major infection, as determined by the
             investigator.

          -  Received any investigational drugs or devices less than or equal to 30 days prior to
             transplantation.

          -  Known or suspected allergy to sirolimus (SRL), tacrolimus (TAC), inosine-monophosphate
             dehydrogenase (IMPDH) inhibitor, macrolide antibiotics, iothalamate, iodine,
             iodine-containing products, including contrast media other compounds related to these
             products/classes of medication, or shellfish.

          -  History of malignancy less than or equal to 3 years of screening (except for
             adequately treated basal cell or squamous cell carcinoma of the skin).

          -  Recipients who are known to be human immunodeficiency virus (HIV) positive.

          -  Women who are biologically capable of having children with a positive urine or serum
             pregnancy test at screening.

          -  Breastfeeding women.

        At Randomization:

          -  Any major illness/condition that, in the investigator's judgment, will substantially
             increase the risk associated with the subject's participation in and completion of the
             study, or could preclude the evaluation of the subject's response.

          -  Planned treatment with immunosuppressive therapies other than those described in the
             protocol.

          -  Subjects who underwent corticosteroids withdrawal or avoidance and did not receive
             antibody induction at the time of transplantation with anti-thymocyte globulin
             (rabbit) (rATG) (Thymoglobulin®), anti-thymocyte globulin (equine) (Atgam®), or
             alemtuzumab (Campath®).

          -  Subjects who have had corticosteroid (CS) discontinued less than or equal to 30 days
             before randomization.

          -  Calculated glomerular filtration rate (GFR) less than 40 mL/min/1.73m2 using the
             simplified Modification of Diet in Renal Disease (MDRD) formula less than or equal to
             2 weeks prior to randomization.

          -  Spot urine protein to creatinine ratio (UPr/Cr) greater than or equal to 0.5 less than
             or equal to 2 weeks prior to randomization.

          -  Banff (2007) grade 2 or higher acute T-cell-mediated or any acute antibody-mediated
             rejection at any time post-transplantation.

          -  Any acute rejection (biopsy-confirmed or presumed) less than or equal to 30 days
             before randomization.

          -  More than 1 episode of acute rejection (biopsy-confirmed or presumed).

          -  Known Banff (2007) interstitial fibrosis and tubular atrophy (IF/TA) greater than or
             equal to grade 2 or recurrent/de novo glomerular disease.

          -  Major surgery less than or equal to 2 weeks prior to randomization.

          -  Active post-operative complication, e.g. infection, delayed wound healing.

          -  Total white blood cell count less than 2,000/mm3 or absolute neutrophil count (ANC)
             less than 1000 or platelet count less than 100,000/mm3 less than or equal to 2 weeks
             prior to randomization.

          -  Fasting triglycerides greater than 400 mg/dL (greater than 4.5 mmol/L) or fasting
             total cholesterol greater than 300 mg/dL (greater than 7.8 mmol/L) less than or equal
             to 2 weeks prior to randomization regardless of whether or not on lipid-lowering
             therapy.

          -  Women who are biologically capable of having children with a positive urine or serum
             pregnancy test at randomization.

          -  Breastfeeding women.