Everolimus bAsed caLcineurin inhibiTor frEe immunosuppRession oNe Year AfTer lIver transplantatiON (ALTERNATION)

Starting soon · Phase 3

Conditions studied: Liver Allograft, Liver Diseases, Liver Transplantation

In brief

The overall aim of this study is nephroprotection based on a calcineurin inhibitor (CNI)-free therapy beyond year one after orthotopic liver transplantation (OLT) in highly pre-selected patients with low rejection risk.

Key facts

Study ID

NCT07739914

Run by

Hannover Medical School

People needed

150

Starts

2026-06-30

Expected to finish

2031-06-30

Last updated by the study team

2026-07-31

Who can join

Age: 18 and older, up to 80. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Men**, women*, inter/diverse aged ≥ 18 or <80 years
• Signed written informed consent from subject
• Liver allograft recipients, either deceased or living donor liver transplant
• Liver transplantation more than 12 months ago and less than 36 months ago
• Recipients of single organ transplant only
• LTR on CNI-based maintenance IS
• Liver enzymes: ALT < 2x ULN and ALP< 2 ULN
• *Women without childbearing potential defined as follows:
• at least 6 weeks after surgical sterilization by bilateral tubal ligation or bilateral oophorectomy or
• hysterectomy or uterine agenesis or
• ≥ 50 years and in postmenopausal state > 1 year or
• < 50 years and in postmenopausal state > 1 year with serum FSH > 40 IU/l and serum estrogen < 30 ng/l or a negative estrogen test, both at screening or
• Women of childbearing potential:
• who are practicing sexual abstinence (periodic abstinence and withdrawal are not acceptable) or
• who have sexual relationships with female partners only and/or with sterile male partners or
• who are sexually active with fertile male partner, have two negative pregnancy tests with a sensitivity of at least 25 mIU/ml during screening (it is recommended that the second test be performed 8-10 days after the first test) and agree to use at least one highly *** from the time of screening until 8 weeks after completion of treatment (or even 90 days for males if MMF has been taken previously). Preferably, two complementary forms of contraception should be used simultaneously. Pregnancy tests should be repeated if clinically indicated (e.g. after a contraceptive failure has been reported).

You may not qualify if…

• Previous CNI-free IS
• Acute or chronic rejection within the 36 months prior to screening
• Prednisolone intake due to another autoimmune disease for more than 8 weeks
• eGFR <30ml/min and/or proteinuria >0.5g/l (to mitigate the risk of worsening renal failure should rejection occur and high level of CNI might be required and proteinuria as a contraindication for mTORI-based therapy)
• Need for chronic anti-coagulation that cannot be safely discontinued to perform a liver biopsy
• Inability to participate in frequent monitoring of liver function (every 8 weeks) and clinical visits during the trial duration (38 months)
• Malignancy or active infection including active, replicative viral hepatitis (chronic hepatitis does not belong to exclusion criteria)
• Recurrence of underlying liver disease
• Subjects who are pregnant or breastfeeding
• Hypersensitivity or intolerance to any of the components of the medications used
• Participation in another clinical trial (other investigational drugs or devices at the time of enrolment or within 30 days prior enrolment or within five half-lives of the Investigational Medicinal Product (IMP), whichever is longer)
• Any medical condition which could compromise participation in the study according to the investigator's assessment.
• Accommodation in an institution pursuant to a court or administrative order
• Histological exclusion criteria in the baseline screening biopsy:
• more than mild portal tract inflammation, presence of interface hepatitis, more than mild lobular inflammation
• presence of biliary inflammation, endothelialitis, portal microvasculitis, central perivenulitis
• advanced fibrosis (≥2 in any scale of LAF score)
• evidence of acute or chronic rejection (T cell-mediated or antibody-mediated, plasma-cell-rich, chronic ductopenic rejection)

Where it is running

• RWTH Aachen University Hospital, Clinic for Gastroenterology, Metabolic Disorders, and Internal Intensive Medicine (Medical Clinic III) — Aachen, North Rhine-Westphalia, Germany
• University Hospital Bonn, Department of General, Visceral, Transplant, and Vascular Surgery — Bonn, North Rhine-Westphalia, Germany
• University Hospital Essen, Department of Gastroenterology, Hepatology, and Transplant Medicine — Essen, North Rhine-Westphalia, Germany
• University Hospital Münster, Department of Internal Medicine B Gastroenterology, Hepatology, Endocrinology, Clinical Infectious Diseases — Münster, North Rhine-Westphalia, Germany
• University Medical Center of Johannes Gutenberg University Mainz, Department of Internal Medicine I — Mainz, Rhineland-Palatinate, Germany
• Otto von Guericke University Magdeburg, Department of Visceral, Vascular, and Transplant Medicine — Magdeburg, Saxony-Anhalt, Germany
• Schleswig-Holstein University Hospital (UKSH), Department of General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Campus Kiel — Kiel, Schleswig-Holstein, Germany
• Charité - University Hospital Berlin; Department of Surgery — Berlin, State of Berlin, Germany
• University Hospital Jena, Department of General, Visceral, and Vascular Surgery — Jena, Thuringia, Germany
• University Hospital Heidelberg; Department of Internal Medicine IV — Heidelberg, Baden-Wurttemberg, Germany
• University Hospital Tübingen, Department of Internal Medicine I — Tübingen, Baden-Wurttemberg, Germany
• University Hospital Regensburg, Department of Surgery — Regensburg, Bavaria, Germany
• University Hospital Würzburg, Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery — Würzburg, Bavaria, Germany
• University Medical Center Hamburg, I. Department of Medicine, Department of Hepatobiliary and Transplantation Surgery — Hamburg, Free and Hanseatic City of Hamburg, Germany
• Medical School Hannover, Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases — Hanover, Lower Saxony, Germany
• University Medical Center Rostock, Interdisciplinary Transplant Center, Department of General, Visceral, Thoracic, Vascular, and Transplant Surgery — Rostock, Mecklenburg-Vorpommern, Germany

Full record on ClinicalTrials.gov

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