Multicenter Clinical Trial to Evaluate the Efficacy of a Preventive Strategy Against CMV Infection in Heart Transplant Patients Based on the Specific T Cells Response

  • STATUS
    Recruiting
  • End date
    Mar 25, 2023
  • participants needed
    188
  • sponsor
    Hospital Universitari de Bellvitge
Updated on 28 January 2021
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Summary

This study evaluates the efficacy and safety of an individualized preventive strategy against CMV infection in CMV seropositive heart transplant patients based on the specific basal response of the lymphocytes againts CMV (ELISPOT Interferon- assay).

In two thirds of the patients a preventive strategy will be carried out based on the result of the ELISPOT IFN- assay and in one third of the patients the standard of care strategy will be carried out (universal prophylaxis).

Description

Background: The prevention of Cytomegalovirus (CMV) infection in cardiac transplant patients is currently based exclusively on the performance of the serotypes of the receptor and the donor. Despite prophylactic treatment with valganciclovir or preemptive therapy through serial monitoring of blood viral copies, the rate of infection or CMV disease remains high and has a negative clinical impact. The evaluation of the specific T lymphocytes cellular immune response against 2 CMV antigens prior to kidney transplantaction, using the ELISPOT IFN- assay discriminates in a better way which patients will develop CMV infection.

Objetives: To compare the cumulative incidence of CMV infection during the first year post-heart transplant amongst CMV seropositive recipients in 12 national centers, where the prophylactic strategy regarding CMV infection will be guided by the ELISPOT IFN- assay or not (control). Main variable: number of patients who have CMV infection in the first year post-trasplant (HT).

Hyphotesis: A preventive strategy against CMV infection in CMV seropositive heart transplant patients, based on the specific basal response of the T lymphocytes against CMV, ELISPOT IFN- assay, is effective, safe and not inferior than the control group in terms of infection CMV rates. Design: The investigators propose a phase IV clinical trial (with authorized treatment), randomized (2:1), controlled, open label and multicentric, with two parallel groups (Experimental group: preventive strategy based on the ELISPOT IFN- result: If patients are stratified as high risk they will receive prophylaxis with valgancyclovir for 3 months and if they are stratified as low risk they will be treated with preemptive therapy guided by CMV polymerase chain reaction analysis; Control group: Standard of care, universal prophylaxis with valgancyclovir for 3 months).

Follow-up: 1 year. Duration of the trial: 3 years. Sample size: 188 patients.

Details
Condition Cytomegalic Inclusion Disease, Cytomegalovirus (CMV) Retinitis, Cytomegalovirus Infections, Cytomegalovirus, Cytomegalovirus (CMV) Retinitis, Heart Transplant Infection, HCMV Infection, Cytomegalovirus Infections, cytomegalovirus infection, cmv infection
Treatment ELISPOT IFN-γ assay
Clinical Study IdentifierNCT04278547
SponsorHospital Universitari de Bellvitge
Last Modified on28 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Adult patients (18 years or more), both sexes, heart transplant patients
Patients with positive IgG against CMV (seropositive)
Informed consent given by the subject or his legal representative
Availability of obtaining recipient and donor serologies
Availability of obtaining biological samples of peripheral blood post-transplant to be able to perform the ELISPOT IFN- assay
Women of childbearing age who use effective contraceptive measures during and until, so less, 30 days after treatment. Men who use contraceptive measures of barrier during and for at least 90 days after treatment, unless there is certainty that the female partner does not run the risk of becoming pregnant

Exclusion Criteria

Pregnancy and / or breastfeeding period
Patients with contraindication for the use of valganciclovir or ganciclovir
Patients receiving thymoglobulin as induction therapy
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