Resection And Partial LIver Transplantation With Delayed Hepatectomy for Hepatocellular Carcinoma (RAPID-HCC)
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ClinicalTrials.gov Identifier: NCT05971628 |
Recruitment Status :
Not yet recruiting
First Posted : August 2, 2023
Last Update Posted : August 2, 2023
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Condition or disease | Intervention/treatment | Phase |
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Hepatocellular Carcinoma | Procedure: RAPID procedure | Not Applicable |
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Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 50 participants |
Allocation: | Non-Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Resection And Partial LIver Transplantation With Delayed Hepatectomy for Hepatocellular Carcinoma |
Estimated Study Start Date : | September 2023 |
Estimated Primary Completion Date : | October 2027 |
Estimated Study Completion Date : | June 2029 |
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Arm | Intervention/treatment |
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Experimental: Liver transplantation with the RAPID procedure
Liver transplantation for hepatocellular carcinoma according to the RAPID protocol. This protocol is an auxiliary liver transplantation of a partial graft with total hepatectomy in two stages (2 successive operations).
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Procedure: RAPID procedure
RAPID procedure stands for Resection And Partial Liver Transplantation with Delayed Hepatectomy for hepatocellular carcinoma |
No Intervention: Comparator group with standard liver transplantation (whole graft)
Orthotopic liver transplantation with whole organ from deceased donor for hepatocellular carcinoma. Data will be provided by Biomedicine Agency, following pairing rules.
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- Proportion of patient with successful RAPID procedure [ Time Frame: 4 months after the second RAPID step ]
Success of the procedure will be assessed as a patient :
- who complete the 2 steps of the procedure,
- who had no graft resection and who is still alive 4 months later.
- Tolerance of the RAPID procedure [ Time Frame: from first stage of the surgical protocol and until 90 days after the second stage ]Tolerance will be assessed with Adverse events related to the procedure
- Proportion of grafts in place [ Time Frame: 4 months after the first surgical step ]Number of patients with a graft in place at 4 months after the first surgical step
- Survival of grafts at 2 years from liver transplantation (LT) [ Time Frame: at 2 Years from LT ]Survival RAPID grafts considered in the event of a graft still in place Non-survival in the event of the patient's death or new LT
- Survival of patient at 2 year after their registration on the waiting list of transplantation [ Time Frame: at 2 year after their registration on the waiting list of transplantation ]whatever the cause of death
- Survival of patient at 2 year after LT [ Time Frame: at 2 year after LT ]
- Incidence of rejection after RAPID [ Time Frame: at 2 years after the first stage of RAPID ]Identification of histologically proven rejections within 2 years after the first stage of RAPID.
- Waiting time between listing on the waiting list and LT according to RAPID [ Time Frame: 1 year ]Time between registration the waiting list and TH according to RAPID (1st step)
- Gain of grafts [ Time Frame: 70 months ]Number of left lobes transplanted according to RAPID protocol - the number of retransplantations = organ gain obtained. Will be also analysed, the number of right livers generated and transplanted, as well as the number of complete RAPID procedures (native liver excision) will also be analyzed.
- Comparison of the drop-out rate between RAPID group and control group [ Time Frame: 18 months ]Drop out will be estimated by exclusion from the LT program, whatever the cause : death, worsening, transplant refusal, etc.
- Comparison of the waiting time between registration on the transplantation list and LT between RAPID group and control group [ Time Frame: up to 18 months ]Patients who completed the 1st RAPID phase compared to the control group
- Comparison of the graft survival at 2 years after LT between RAPID group and control group [ Time Frame: at 2 years after 1rst stage of RAPID ]
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Ages Eligible for Study: | 18 Years to 68 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion criteria (RAPID receiver)
- 18 years ≤ age ≤ 68 years
- Indication of LT for HCC validated in multidisciplinary meeting
- AFP score ≤ 2 (15)
- Body mass index < 30 kg/m2
- MELD score ≤ 15, without access to prioritization
- PET CT-choline and PET CT-FDG without sign of extra-hepatic localizaton
- Patient having been informed and able to give written consent to participate in the RAPID-HCC study
- Validation of the patient's inclusion in the RAPID-HCC protocol by the scientific committee
Exclusion criteria
- History of, liver transplant, surgical or radiological portocaval anastomosis
- History of major abdominal surgery (including hepatectomy)
- History of abdominal radiotherapy (extrahepatic)
- History of acute/chronic pancreatitis
- Expected combined transplant
- HCC located 1 cm away from the transection line required by the first stage hepatectomy
- Portal or arterial thrombosis
- patient with a pre-graft hepatic venous pressure gradient ≥ 20mmHg
- Ascites (clinical or radiological) less than 5 years ago
- Hepatitis C viral load +
- Acute or chronic hepatitis B (not cured)
- HIV + serology
- Severe comorbidities, in particular severe cardiovascular or respiratory or renal pathology (at the discretion of the medical-surgical team)
- Patient on anticoagulant treatment
- Patient who has received (or is due to receive) preoperative treatment with radioembolization on the right side, hepatectomy or radiotherapy near the hilum
- Patient who received (or should receive) preoperative treatment with anti-tyrosine kinase (TKI) less than three months ago
- Patients receiving or having received immunotherapy
Donor selection criteria:
- Brain-dead donor (no living donor)
- 18 years ≤ age ≤ 65 years
- Hepatic, vascular and biliary anatomy compatible with performing a split. Analysis entrusted to the team that will carry out the split, and based on the scanner of the donor (to be available on the Biomedicine Agency website)
- Biological and hepatic assessment compatible with the realization of a split, in particular transaminases < 4 times the normal
- Graft not assigned to a protocol requiring machine infusion.
- Serology: anti-HBc negative, anti-HCV negative
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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05971628
Contact: Nicolas GOLSE, Doctor | 3306 71 28 24 03 | nicolas.golse@aphp.fr |
France | |
AP-HP, Paul Brousse Hospital | |
Villejuif, France, 94800 | |
Contact: Nicolas GOLSE, Doctor nicolas.golse@aphp.fr |
Principal Investigator: | Nicolas GOLSE, Doctor | APHP, Paul Brousse Hospital, villejuif, France |
Responsible Party: | Assistance Publique - Hôpitaux de Paris |
ClinicalTrials.gov Identifier: | NCT05971628 |
Other Study ID Numbers: |
APHP210351 |
First Posted: | August 2, 2023 Key Record Dates |
Last Update Posted: | August 2, 2023 |
Last Verified: | June 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
liver transplantation split auxiliary transplantation Hepatocellular Carcinoma |
Carcinoma Carcinoma, Hepatocellular Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Adenocarcinoma |
Liver Neoplasms Digestive System Neoplasms Neoplasms by Site Digestive System Diseases Liver Diseases |