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The purpose of this study is to investigate the use of ECP for lung-transplanted patients to reduce the occurrence of acute and chronic rejection and CMV-infection.
The intention of the planned study is the use of ECP as a form of induction treatment in combination with standard triple-drug immunosuppressive therapy (IS). This is a single-center prospective randomized controlled trial conducted at Medical University of Vienna between 2018 and 2020. It includes 31 COPD recipients per group. Treatment group underwent ECP with in addition to IS after lung transplantation. Control group received only IS. The primary outcome was a composite outcome defined as incidence of high-grade ACR, CMV infection or CLAD within 24 months after lung transplantation.
Parallel to the clinical parameters, immunologic investigations will be performed to get a better insight into the mechanisms of ECP on the immune system. The dynamics of Tregs and dentritic cell will be analyzed to compare the influence of ECP vs standard IS.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ECP with standard triple IS | Experimental |
| |
| standard triple IS | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ECP (Extracorporeal Photopheresis System) | Device | Patients who are assigned to the ECP group receive treatments by means of the THERAKOS ® CELLEX ® Photopheresis System (Mallinckrodt Pharmaceuticals Inc.) with either double- or single-needle access. During the leukapheretic processing, 1500 ml of whole blood is processed, and peripheral blood mononuclear cells (MCNs) are separated by centrifugation and collected in the buffy coat. 8-methoxypsoralen (Uvadex®, Mallinckrodt Pharmaceuticals Inc.) at a dose of 20 μg/ml is added to the MNC collection bag and cells are irradiated with ultraviolet A light (1.5 J/cm2) in a 1-mm-thick film through a photoactivation plate. After exposure of the cells to the ultraviolet light, the buffy coat is reinfused into the patient. |
| Measure | Description | Time Frame |
|---|---|---|
| Composite endpoint | the incidence of high-grade ACR, cytomegalovirus (CMV) infection or CLAD | 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of ACR and of lymphocytic bronchiolitis (LB) | Frequency of ACR and of lymphocytic bronchiolitis (LB) | 24 months |
| Incidence of clinically treated infections | Incidence of clinically treated infections |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical University Vienna | Vienna | 1090 | Austria |
To evaluate the safety and efficacy of ECP in addition to a standard triple immunosuppressive therapy consisting of Tacrolimus (Tac), Mycophenolate Mofetile (MMF) and corticosteroids to prevent rejection and infections.
Available for the next 6 months
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| 24 months |
| Detection of plasma CMV DNA | Detection of plasma CMV DNA | 24 months |
| Patient survival | Patient survival | 36 months |
| Graft survival | Graft survival | 36 months |
| Incidence of de-novo donor specific antibodies | Incidence of de-novo donor specific antibodies | 24 months |
| Number of AMR episodes | Number of AMR episodes | 24 months |
| Incidence of CLAD | Incidence of CLAD | 36 months |