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10°C vs 4°C Lung Preservation RCT

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05898776
Recruitment Status : Recruiting
First Posted : June 12, 2023
Last Update Posted : May 30, 2024
Sponsor:
Collaborators:
Medical University of Vienna
Vanderbilt University
Puerta de Hierro University Hospital
University of California, San Francisco
Centre Hospitalier Universitaire Vaudois
Information provided by (Responsible Party):
University Health Network, Toronto

Brief Summary:

Despite lung transplantation (LTx) being the most effective treatment for end-stage lung disease, its success rate is lower than that of other solid organ transplantations. Primary graft dysfunction (PGD) is the most common post-operative complication and a major factor in early mortality and morbidity, affecting ~25% of lung transplant patients. Induced by ischemia reperfusion, PGD represents a severe and acute lung injury that occurs within the first 72 hours after transplantation, and has a significant impact on short- and long-term outcomes, and a significant increase in treatment costs. Any intervention that reduces the risk of PGD will lead to major improvements in short- and long-term transplant outcomes and health care systems.

One of the main strategies to reduce the risk and severity of post-transplant PGD is to improve pre-transplant donor lung preservation methods. In current practice, lung preservation is typically performed by cold flushing the organ with a specialized preservation solution, followed by subsequent hypothermic storage on ice (~4°C). This method continues to be used and applied across different organ systems due to its simplicity and low cost. Using this method for the preservation of donor lungs, the current maximum accepted preservation times have been limited to approximately 6-8h. While the goal of hypothermic storage is to sustain cellular viability during ischemic time through reduced cellular metabolism, lower organ temperature has also been shown to progressively favor mitochondrial dysfunction. Therefore, the ideal temperature for donor organ preservation remains to be defined and should maintain a balance between avoidance of mitochondrial dysfunction and prevention of cellular exhaustion. In addition to that, safe and longer preservation times can lead to multiple advantages such as moving overnight transplants to daytime, more flexibility to transplant logistics, more time for proper donor to recipient matching etc.

Building on pre-clinical research suggesting that 10°C may be the optimal lung storage temperature, a prospective, multi-center, non-randomized clinical trial was conducted at University Health Network, Medical University of Vienna and Puerta de Hierro Majadahonda University Hospital. Donor lungs meeting criteria for direct transplantation and with cross clamp times between 6:00pm - 4:00am were intentionally delayed to an earliest allowed start time of 6:00am and a maximum preservation time from donor cold flush to recipient anesthesia start time of 12 hours. Lungs were retrieved and transported in the usual fashion using a cooler with ice and transferred to a 10°C temperature-controlled cooler upon arrival to transplant hospital until implantation. The primary outcome of this study was incidence of Primary Graft Dysfunction (PGD) Grade 3 at 72h, with secondary endpoints including: recipient time on the ventilator, ICU Length of Stay (LOS), hospital LOS, 30-day survival and lung function at 1-year. Outcomes were compared to a contemporaneous conventionally transplanted recipient cohort using propensity score matching at a 1:2 ratio. 70 patients were included in the study arm. Post-transplant outcomes were comparable between the two groups for up to 1 year. Thus, intentional prolongation of donor lung preservation at 10°C was shown to be clinically safe and feasible.

In the current study design, the investigators will conduct a multi-centre, non-inferiority, randomized, controlled trial of 300 participants to compare donor lung preservation from the time of explant to implant at ~10°C in X°Port Lung Transport Device (Traferox Technologies Inc.) vs a standard ice cooler. When eligible donor lungs become available for a consented recipient, the lungs will be randomized to undergo a preservation protocol using either 10°C (X°Port Lung Transport Device, Traferox Technologies Inc.) or standard of care. The primary outcome of the study is incidence of ISHLT Primary Graft Dysfunction Grade 3 at 72 hours. Post-transplant outcomes will be followed for one year.


Condition or disease Intervention/treatment Phase
Lung Transplant Organ Preservation Device: Lung transplantation after 10°C donor lung preservation Device: Lung transplantation after standard ice cooler donor lung preservation Not Applicable

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Safety of 10°C Lung Preservation vs. Standard of Care: A Multi-Centre Prospective Non-Inferiority Trial
Actual Study Start Date : June 9, 2023
Estimated Primary Completion Date : July 31, 2025
Estimated Study Completion Date : July 1, 2026

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: 10°C lung preservation Device: Lung transplantation after 10°C donor lung preservation
When suitable donor lungs become available for a, eligible, consented recipient and meet criteria to go straight to transplantation, the lungs randomized to 10°C preservation will be stored, transported and preserved in the X°Port Lung Transport Device (Traferox Technologies Inc.) until implant with a maximum time of 12 hours between the donor and recipient surgeries.

Active Comparator: Standard lung preservation Device: Lung transplantation after standard ice cooler donor lung preservation
When suitable donor lungs become available for a, eligible, consented recipient and meet criteria to go straight to transplantation, the lungs randomized to standard preservation will be will be stored, transported and preserved in an ice cooler (~4°C, standard of care) until implant with a maximum time of 6 hours between the donor and recipient surgeries.




Primary Outcome Measures :
  1. Incidence of Primary Graft Dysfunction (PGD) Grade 3 as per International Society for Heart and Lung Transplantation (ISHLT) [ Time Frame: 72 hours post-transplant ]
    PGD is graded on a scale of 0 to 3 based on ISHLT guidelines, where PGD Grade 3 indicates severe primary graft dysfunction.


Secondary Outcome Measures :
  1. Incidence of Primary Graft Dysfunction Grade 2-3 as per International Society for Heart and Lung Transplantation [ Time Frame: 0 (ICU arrival), 24, 48, and 72 hours post-transplant ]
    PGD is graded on a scale of 0 to 3 based on ISHLT guidelines, where PGD Grade 3 indicates severe primary graft dysfunction.

  2. Time on ventilator [ Time Frame: Index hospitalization (up to 1 year) ]
  3. Total ICU and hospital length of stay [ Time Frame: Index hospitalization (up to 1 year) ]
  4. Overall survival [ Time Frame: 30 days, 1 year post-transplant ]
  5. Occurrence of acute rejection [ Time Frame: 1 year post-transplant ]
  6. Six minute walk test [ Time Frame: 1 year post-transplant ]
  7. Forced expiratory volume - one second (FEV1 in L) [ Time Frame: 1 year post-transplant ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Donor Inclusion Criteria

  • Donation after brain death (DBD) or donation after cardiac death (DCD)
  • Donor lungs are suitable to go straight to LTx (i.e., do not need ex vivo lung perfusion (EVLP) assessment)

Donor Exclusion Criteria

  • Concerns with organ preservation technique
  • Need for EVLP assessment

Recipient Inclusion Criteria

  • 18-80 years old
  • Primary lung transplantation
  • Bilateral lung transplantation

Recipient Exclusion Criteria

  • Re-transplantation
  • Multi-organ transplantation
  • Single lung transplantation
  • Participation in a contraindicating trial

Information from the National Library of Medicine

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): NCT05898776


Contacts
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Contact: Sharaniyaa Balachandran 416-340-4800 ext 6549 sharaniyaa.balachandran@uhn.ca

Locations
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United States, California
University of California San Francisco Recruiting
San Francisco, California, United States, 94143
Contact: Jasleen Kukreja, MD MPH       Jasleen.Kukreja@ucsf.edu   
Principal Investigator: Jasleen Kukreja, MD MPH         
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Anil J Trindade, MD       anil.trindade@vumc.org   
Principal Investigator: Anil J Trindade, MD         
Austria
Medical University of Vienna Recruiting
Vienna, Austria
Contact: Konrad Hoetzenecker, MD PhD       konrad.hoetzenecker@meduniwien.ac.at   
Principal Investigator: Konrad Hoetzenecker, MD PhD         
Canada, Ontario
University Health Network (Toronto General Hospital) Recruiting
Toronto, Ontario, Canada, M5G 2C4
Contact: Sharaniyaa Balachandran    416-340-4800 ext 6549    sharaniyaa.balachandran@uhn.ca   
Principal Investigator: Elliot Wakeam, MD MPH         
Sub-Investigator: Marcelo Cypel, MD MSc         
Sub-Investigator: Shaf Keshavjee, MD MSc         
Sub-Investigator: Tom Waddell, MD PhD         
Spain
Hospital Universitario Puerta de Hierro-Majadahonda Recruiting
Madrid, Spain
Contact: Jose L Campo-Cañaveral de la Cruz, MD PhD       campo-canaveral.delacruz@salud.madrid.org   
Principal Investigator: Jose L Campo-Cañaveral de la Cruz, MD PhD         
Switzerland
Centre Hospitalier Universitaire Vaudois (CHUV) Not yet recruiting
Lausanne, Switzerland
Contact: Thorsten Krueger, MD       Thorsten.Krueger@chuv.ch   
Principal Investigator: Thorsten Krueger, MD         
Sponsors and Collaborators
University Health Network, Toronto
Medical University of Vienna
Vanderbilt University
Puerta de Hierro University Hospital
University of California, San Francisco
Centre Hospitalier Universitaire Vaudois
Investigators
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Principal Investigator: Elliot Wakeam, MD MPH University Health Network, Toronto
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Responsible Party: University Health Network, Toronto
ClinicalTrials.gov Identifier: NCT05898776    
Other Study ID Numbers: 22-5909
First Posted: June 12, 2023    Key Record Dates
Last Update Posted: May 30, 2024
Last Verified: April 2024

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No