Rejection Diagnosis in Kidney Transplants Patients

Study Overview
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Brief Summary
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Main objective: To constitute a prospective multicentre French cohort of kidney transplant recipients including clinical, biological and immunological evaluation combined with non-invasive biomarkers in peripheral blood and urine, and gene expression assessment in allograft biopsy in order to increase the performance of rejection diagnosis in kidney transplant patients. the investigators hypothesise that the addition of non-invasive biomarkers and intragraft assessment of gene expression profiles will improve the diagnosis capacity of histology in kidney transplant recipients as it reveals pathophysiological pathways that are not captured by light microscopy.

Detailed Description
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Rejection currently represents the major cause of allograft failure worldwide, with immediate consequences for the patients in terms of mortality, morbidity and costs for the society. The field of transplantation lacks robust assessments for immune monitoring and diagnoses. Currently, light microscopy still represents the gold standard, which has clearly been identified as imperfect. Given those facts, success of clinical trials is impaired with space for improvement of current diagnosis standards that should eventually lead to improved outcomes for kidney transplant recipients. This study will provide the investigators with prospective data of kidney transplant patient that will allow the improvement of rejection diagnosis and individual immune monitoring for precision medicine: improvement of rejection diagnosis, stage and assessment of response to therapy. In order to estimate for each patient a probability of rejection, The investigators will generate algorithms using traditional clinical, biological and histological data that will be enriched by tissue as well as blood and urine non-invasive immune biomarkers. These algorithms will be encapsulated in a user-friendly web-based application with best in-class visualisation : the TransplanScreen will display individual information with comparative and predictive context for clinicians and patients and better interfacing and communication. It will include a comprehensive TransplanScreen report based on the algorithms and included in Electronic Medical Record databases (object-oriented). It aims to provide visual and contextual information to promote personalised decision making, addressing the demand of public health authorities for improving efficiency and quality of care. The expected benefit for participants and society will be to reduce the financial burden of graft rejection for society. The cohort will include n=750 kidney transplant recipients in 8 French centres : 3 Parisian ones: Necker hospital, Saint-Louis Hospital and Bichat hospital and 4 regional ones: CHU Nantes, Toulouse and Bordeaux, Montpellier and Lyon Hospitals. Bichat hospital will not be recruiting but will contribute to the research. Vulnerable participants excluded. Schedule for the study: inclusion period: 12 months participation period (treatment - follow-up): 12 months total duration of the study: 24 months Exclusion period for participation in other studies, and justification: the participation to other minimal risks and constraints studies and observational non-interventional studies is allowed during this study. There is no exclusion period at the end of study. The participation to other interventional and observational non-interventional studies is allowed after the end of the study. Number of enrolments expected per site and per month : Necker Hospital: 14 patients / month Saint-Louis Hospital: 8 patients / month CHU Nantes: 10 patients / month Lyon Hospitals: 9 patients / month CHU Toulouse: 13 patients / month CHU Bordeaux: 9 patients / month. CHU Montpelier: 8/month

Official Title
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Prospective KTD-innov Cohort of Kidney Transplants Patients

Conditions
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Kidney Transplantation, Transplant Rejection, Graft Survival

Intervention / Treatment
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* Procedure: Kidney transplantation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men or female patients, Age ≥ 18 years old at the time of transplantation. Patients receiving a kidney transplant from a living or deceased donor. Patients who signed the informed consent form and willing to comply with study procedures. Female patients of child-bearing potential must have a negative pregnancy test (serum beta-hCG) and must be practicing an effective, reliable and medically approved contraceptive regimen Patients with a minimum weight of 40 kg Exclusion Criteria: History of multi-organ transplant (interference with rejection natural history). Unable/unwilling to comply with study procedures (including foreign language speakers who are not assisted by a native French speaker). Vulnerable participants (minors, protected adults, pregnant women, legally detained

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Prospective cohort<br>Kidney transplantation | Procedure: Kidney transplantation<br>* For the patients with the kidney transplantation, these parameters will be analysis: Transcriptomics analysis Characteristics of anti HLA DSA analysis Non-HLA antibodies analysis Omics blood analysis Urine chemokines analysis<br>* Other names: Characteristics of anti HLA DSA analysis;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Concordance of invasive/non-invasive biomarkers with allograft rejection | Concordance of invasive/non-invasive biomarkers with allograft rejection diagnosed by the gold standard (histology) in kidney transplant recipients. | month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Association of non-invasive biomarkers with different subtypes of rejection | Association of non-invasive biomarkers with different subtypes of rejection | month 12 | 
| Association of gene sets with different subtypes of rejection in the biopsy. | Association of gene sets with different subtypes of rejection in the biopsy. | month 12 | 
| Reclassification capacity of gene sets and non-invasive biomarkers to define allograft rejection. | Reclassification capacity of gene sets and non-invasive biomarkers to define allograft rejection | month 12 | 
| Variation of the non-invasive biomarker signature of allograft rejection | ariation of the non-invasive biomarker signature of allograft rejection as a response to the standard of care in kidney transplant recipients. | month 12 | 
| Variation of the gene set signature | Variation of the gene set signature of allograft rejection from the biopsy as a response to the standard of care in kidney transplant recipients. | month 12 | 
| Cumulative incidence of antibody-mediated rejection (ABMR) | Cumulative incidence of antibody-mediated rejection (ABMR) that occurs between D0 and M12 (ABMR that meets Banff 2015 criteria) | month 12 | 
| Cumulative incidence of T-cell-mediated rejection (TCMR) | Cumulative incidence of T-cell-mediated rejection (TCMR) that occurs between D0 and M12 (TCMR that meets Banff 2015 criteria) | month 12 | 
| Treatment failure rate | Treatment failure rate defined as the occurrence of 1) biopsy proven ABMR and/or TCMR, 2) graft loss, 3) patient death | month 12 | 
| Graft and patient survival | Graft and patient survival at M6 and M12 post-transplantation | month 12 | 
| Histological evidence of ABMR and/or TCMR on protocol biopsies | Histological evidence of ABMR and/or TCMR on protocol biopsies without other clinical findings at M3 and M12 post-transplantation | month 12 | 
| Overall pathological changes, including chronic ABMR | Overall pathological changes, including chronic ABMR, on protocol biopsies M3 and M12 post-transplantation | month 12 | 
| Incidence of delayed graft function | Incidence of delayed graft function (DGF) post-transplantation | month 12 | 
| Cumulative incidence and duration of dialysis. | Cumulative incidence and duration of dialysis between 7 days and M12 post- transplantation | month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Kidney, Allogeneic transplantation, Cohort study, Rejection, Biomarkers, Integrative medicine