Treatment of Chronic Antibody-mediated Rejection in Kidney Transplant With Acthar
This is an open label safety and feasibility trial using Acthar® in addition to the investigators center-specific standard therapy, which could include increase in maintenance immunosuppression, high dose IVIG (2 g/Kg), and/or Rituximab, in patients with CAMR.
- Transplant Glomerulopathy
- Eligible Ages
- Between 18 Years and 80 Years
- Eligible Genders
- Accepts Healthy Volunteers
- Age >18 years
- Morphologic diagnosis of CAMR, by light &/or electron microscopy any time after transplantation
- Current or previously documented donor-specific antibody (DSA) and/or focal or diffuse peritubular capillary C4d staining by immunohistochemistry
- eGFR>25 ml/min
- Diagnosis of malignancy within a year prior to enrollment (except cured cutaneous basal cell or squamous cell carcinoma).
- Lack of evidence of antibody involvement
- Pregnancy, lactation, or refusal to use birth control in women of child bearing potential
- Active infection, or history of HIV
- History of liver or thoracic transplant
- Phase 4
- Study Type
- Intervention Model
- Single Group Assignment
- Primary Purpose
- None (Open Label)
|The study cohort. In this cohort Acthar gel will be administered to the enrolled patient with chrnic AMR.||
- University of Maryland, Baltimore
Study ContactAbdolreza Haririan, MD, MPH
Subjects will receive Acthar® 40 units twice a week subcutaneously for 2 weeks. If the drug is well tolerated the dose will be increased to 80 units twice a week for another 22 weeks. The patients will be maintained on their center-specific standard maintenance regimen, typically consisting of Tacrolimus, mycephenolate mofetil/Sodium, and prednisone.
After screening for the inclusion/exclusion criteria, the patients will be consented and enrolled in the study. The initial visit and subsequent study-related visits at 4, 8, 12, 24, 36 and 52 weeks will include routine evaluation and physical examination and laboratory studies including CBC, electrolyte panel, eGFR, albumin, liver enzymes, and CNI/sirulimus drug level, according to the center's standard of care. DSA will be tested at week 24, and 52 and patients will undergo a biopsy at week 52, as a part of the investigators standard of care. The biopsies will be evaluated by light and electron microscopy using standard histological Banff criteria, and staining for CD68.