Improving Deceased-Donor Kidney Transplant Outcomes Via a Single Intragraft Injection of C1 Esterase Inhibitor (IMPROVE TRIAL)

Recruiting now · Phase 2 · Has a placebo group

Conditions studied: Kidney Transplant

In brief

The purpose of this study is to find out if Berinert can improve kidney function in the first year after transplant and to find out what effects, good or bad, Berinert will have in the kidney recipient. This research study will compare Berinert to placebo. The placebo looks exactly like Berinert but does not contain any active drug. Placebos are used in research studies to see if the results are due to the study drug or due to other reasons. Neither you or the study doctor can choose or know which group is assigned. The primary objective is to test whether intrarenal artery C1 esterase inhibitor (C1INH) injection into the donor kidney prior to transplantation improves kidney function in recipients of high risk, deceased donor kidney transplants as measured by 12-month Estimated Glomerular Filtration Rate (eGFR) Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI)

Key facts

Study ID: NCT06919003
Run by: National Institute of Allergy and Infectious Diseases (NIAID)
People needed: 180
Starts: 2025-09-22
Expected to finish: 2032-05-30
Last updated by the study team: 2026-02-27

Who can join

Age: 18 and older, up to 75. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Participant must be able to understand and provide informed consent
Adults who are on chronic dialysis therapy and are on the wait list for deceased donor kidney transplant
Recipients who are ABO compatible with donor allograft
Negative crossmatch and no donor specific anti-HLA antibody (DSA) on most recent pretransplant serum sample as determined by local site
Female participants of childbearing potential must have a negative pregnancy test upon study entry
All participants with reproductive potential must agree to use highly effective contraception for at least 12-moths post-transplant. Oral estrogen containing contraception must not be used during the first 3 months post-transplant
Hepatitis C Virus Ab positive participants with negative Hepatitis C virus (HCV) Polymerase chain reaction (PCR) are eligible if they have spontaneously cleared infection or are in sustained virologic remission
Hepatitis C Virus negative recipients of a Hepatitis C Virus positive organ are eligible if they will be treated with the intent of inducing a sustained virologic remission
Recipients of kidneys arriving to the transplant center on ex vivo hypothermic machine perfusion pumps are eligible
Recipients of kidneys that received in situ normothermic regional perfusion in the donor are eligible. Kidneys that received normothermic machine perfusion after organ procurement (ex situ normothermic perfusion) are not eligible (See Exclusion #4)
Anticipated Cold Ischemia Time (CIT) >=12 hours
Kidney Donor Profile Index (KDPI) 21-95%. For KDPI 21-34% to be eligible, anticipated CIT must be >=24 hours
Patients with normal coagulation

You may not qualify if…

Inability or unwillingness of a participant to give written informed consent or comply with study protocol
Any prior or concurrent non-renal solid organ, or cellular transplant, or waitlisted for multi-organ transplant. Prior autologous transplant is allowed
Patients receiving enbloc kidneys
Kidneys that received ex vivo normothermic machine perfusion after procurement. Kidneys that received in situ normotherimic regional perfusion in the donor are eligible (see Inclusion #10)
Patients with a known pro-thrombotic disorder
Patients with a history of thrombosis or hyper-coagulable state, excluding dialysis access clotting or other superficial vein thrombosis not requiring long-term systemic treatment
Body mass index (BMI) >=40 kg/m\^2
Patients with a history of Hereditary Angioedema or use of C1 esterase inhibitor (C1INH) containing products or recombinant C1INH within 15 days prior to study entry
Patients with a known hypersensitivity to treatment with Berinert
Patients requiring chronic anti-coagulation or anti-platelet therapy. ASA and NSAIDS are allowed
Presence of active malignancy or history of malignancy less than 5 years in remission, excluding adequately treated in-situ cervical carcinoma, low grade prostate carcinoma, renal cell carcinoma stage T1N0M0 that has been treated with nephrectomy, or adequately treated basal or squamous cell carcinoma of the skin
Patients who are positive for Hep B infection (Hepatitis B surface antigen (HBsAg)+); patients with HbcAB+ are eligible if HBV PCR is negative
Any active infection
Human immunodeficiency virus (HIV) infection
Enrollment in another investigational trial
Recent recipient of any licensed or investigational live attenuated vaccine(s) within 4 weeks of enrollment
Current or planned use of immunomodulatory agents including but not limited to rituximab, belatacept, eculizumab, JAK inhibitors, anti-TNF agents
Female participants who are pregnant or lactating
Past or current medical problems, inclusive of mental health and substance abuse concerns, or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study
History of any stroke (including ischemic, hemorrhagic, or embolic) within the previous 6 months

Where it is running

Cedars Sinai Medical Center — Los Angeles, California, United States (enrolling)
Northwestern Memorial Hospital — Chicago, Illinois, United States (enrolling)
Kansas University Medical Center — Kansas City, Kansas, United States (enrolling)
Montefiore Medical Center — The Bronx, New York, United States (enrolling)

Full record on ClinicalTrials.gov

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