RECRUITING

Kidney Transplant Preemptive Therapy or Prophylaxis for CMV Prevention in D+R Recipients

Description

This is a prospective, randomized multicenter trial of preemptive therapy (PET) vs. antiviral prophylaxis (AP) for prevention of cytomegalovirus (CMV) disease in adult D+R- kidney transplant recipients (KTR). Patients meeting study eligibility criteria and who have provided informed consent will be randomized (1:1) within 7 days of transplant to receive, in an open label design, either AP with valganciclovir 900 mg orally once daily or letermovir 480 mg orally once daily \[both dose adjusted per Food and Drug Administration (FDA) label\] for 200 days post-transplant), or PET (central lab weekly plasma polymerase chain reaction (PCR) monitoring for CMV deoxyribonucleic acidemia (DNAemia)) for 100 days post-transplant, with oral valganciclovir 900mg orally twice daily (or renally dosed per FDA label) at onset of CMV DNAemia at any level and continued until plasma CMV DNAemia is negative or below the level of quantitation in two consecutive weekly plasma samples. Study participants will be followed for pre-specified outcomes (clinical, laboratory, immunologic, safety) until withdrawal, death, or study closure, up to a maximum of 5.5 years post-transplant. Approximately 360 participants (180 participants in each group) will be randomized into the study. Estimated Time to Complete Enrollment: 4 years

Conditions

Cytomegalovirus (CMV)Kidney Transplant; ComplicationsKidney Diseases
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Related Conditions:

Cytomegalovirus (CMV)Kidney Transplant; ComplicationsKidney Diseases

Study Overview

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Study Details

Study overview

This is a prospective, randomized multicenter trial of preemptive therapy (PET) vs. antiviral prophylaxis (AP) for prevention of cytomegalovirus (CMV) disease in adult D+R- kidney transplant recipients (KTR). Patients meeting study eligibility criteria and who have provided informed consent will be randomized (1:1) within 7 days of transplant to receive, in an open label design, either AP with valganciclovir 900 mg orally once daily or letermovir 480 mg orally once daily \[both dose adjusted per Food and Drug Administration (FDA) label\] for 200 days post-transplant), or PET (central lab weekly plasma polymerase chain reaction (PCR) monitoring for CMV deoxyribonucleic acidemia (DNAemia)) for 100 days post-transplant, with oral valganciclovir 900mg orally twice daily (or renally dosed per FDA label) at onset of CMV DNAemia at any level and continued until plasma CMV DNAemia is negative or below the level of quantitation in two consecutive weekly plasma samples. Study participants will be followed for pre-specified outcomes (clinical, laboratory, immunologic, safety) until withdrawal, death, or study closure, up to a maximum of 5.5 years post-transplant. Approximately 360 participants (180 participants in each group) will be randomized into the study. Estimated Time to Complete Enrollment: 4 years

Kidney Transplant Preemptive Therapy or Prophylaxis (KPoP) for CMV Prevention in D+R- Recipients

Kidney Transplant Preemptive Therapy or Prophylaxis for CMV Prevention in D+R Recipients

Condition
Cytomegalovirus (CMV)
Intervention / Treatment

-

Contacts and Locations

San Francisco

University of California, San Francisco School of Medicine, San Francisco, California, United States, 94117

Miami

University of Miami Miller School of Medicine, Miami, Florida, United States, 33136

Atlanta

Emory University School of Medicine, Atlanta, Georgia, United States, 30322

Livingston

Robert Wood Johnson Health Network Barnabas Health, Livingston, New Jersey, United States, 07039

Richmond

Medical College of Virginia Commonwealth, Richmond, Virginia, United States, 23219

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • 1. Subject or legally authorized representative has provided written informed consent.
  • 2. Age ≥ 18 years of age at the time of informed consent.
  • 3. Negative for antibody to CMV as assessed in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory between 28 days prior to transplant and 7 days post-transplant, but prior to enrollment, and no history of positive CMV serology Immunoglobulin G (IgG) antibody
  • 4. Received a first kidney transplant from a CMV seropositive donor in the past 7 days prior to enrollment
  • 5. Individuals of reproductive (childbearing) potential must have a negative pregnancy test (serum or urine) collected prior to randomization (standard of care (SOC) results within 7 days prior to transplant may be used), and must also agree to use a medically approved method of contraception. Acceptable methods include: barrier method, intrauterine device (hormonal or non-hormonal), oral hormonal contraceptives, abstinence from the time of enrollment through 1 month after discontinuation of either PET or AP.
  • 6. If male, and not surgically sterile, must agree to practice barrier method of contraception or abstinence from the time of enrollment through 1 month after discontinuation of either PET or AP.
  • 1. In the opinion of the investigator, participants who are unable or unwilling to undergo preemptive therapy protocol (weekly CMV PCR, etc.)
  • 2. Patients who are breastfeeding or planning to breastfeed within 6 months post-transplant
  • 3. Allergy to valganciclovir/ganciclovir or Letermovir
  • 4. Receipt of immunoglobulin or CMV-specific immunoglobulin within the last 3 months (this includes COVID convalescent plasma)
  • 5. Currently enrolled in another interventional study that, in the investigator's opinion, could affect evaluation of the safety and/or efficacy outcomes
  • 6. Most recent platelet count post-transplant \<25,000/uL
  • 7. Most recent ANC performed post-transplant \<1000/uL
  • 8. Multi-organ transplant or have undergone prior organ transplant
  • 9. Baseline immunodeficiency prior to transplant:
  • 1. Known or suspected human immunodeficiency virus (HIV) infection
  • 2. Congenital or acquired immunodeficiency
  • 10. Unacceptable immunosuppression
  • 1. Receipt of desensitization therapy prior to kidney transplant, or
  • 2. Receipt of a blood type A, B, or O-incompatible kidney transplant, or
  • 3. Receipt or planned receipt of any of the following: belatacept, alemtuzumab, or rituximab

Ages Eligible for Study

18 Years to

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

University of California, San Francisco,

Abhijit P. Limaye, MD, PRINCIPAL_INVESTIGATOR, University of California, San Francisco

Study Record Dates

2031-06-30