Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial
BackgroundLung transplantation (LTx) is the only treatment option for end-stage lung disease. Despite improvements, primary graft dysfunction (PGD) remains the leading cause of early mortality and precipitates chronic lung allograft dysfunction, the main factor in late mortal...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-12-01
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| Series: | JMIR Research Protocols |
| Online Access: | https://www.researchprotocols.org/2023/1/e52553 |
| _version_ | 1797392466750472192 |
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| author | Sandra Lindstedt Martin Silverborn Lukas Lannemyr Leif Pierre Hillevi Larsson Edgars Grins Snejana Hyllen Goran Dellgren Jesper Magnusson |
| author_facet | Sandra Lindstedt Martin Silverborn Lukas Lannemyr Leif Pierre Hillevi Larsson Edgars Grins Snejana Hyllen Goran Dellgren Jesper Magnusson |
| author_sort | Sandra Lindstedt |
| collection | DOAJ |
| description |
BackgroundLung transplantation (LTx) is the only treatment option for end-stage lung disease. Despite improvements, primary graft dysfunction (PGD) remains the leading cause of early mortality and precipitates chronic lung allograft dysfunction, the main factor in late mortality after LTx. PGD develops within the first 72 hours and impairs the oxygenation capacity of the lung, measured as partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2). Increasing the PaO2/FiO2 ratio is thus critical and has an impact on survival. There is a general lack of effective treatments for PGD. When a transplanted lung is not accepted by the immune system in the recipient, a systemic inflammatory response starts where cytokines play a critical role in initiating, amplifying, and maintaining the inflammation leading to PGD. Cytokine filtration can remove these cytokines from the circulation, thus reducing inflammation. In a proof-of-concept preclinical porcine model of LTx, cytokine filtration improved oxygenation and decreased PGD. In a feasibility study, we successfully treated patients undergoing LTx with cytokine filtration (ClinicalTrials.gov; NCT05242289).
ObjectiveThe purpose of this clinical trial is to demonstrate the superiority of cytokine filtration in improving LTx outcome, based on its effects on oxygenation ratio, plasma levels of inflammatory markers, PGD incidence and severity, lung function, kidney function, survival, and quality of life compared with standard treatment with no cytokine filtration.
MethodsThis study is a Swedish national interventional randomized controlled trial involving 116 patients. Its primary objective is to investigate the potential benefits of cytokine filtration when used in conjunction with LTx. Specifically, this study aims to determine whether the application of cytokine filtration, administered for a duration of 12 hours within the initial 24 hours following a LTx procedure, can lead to improved patient outcomes. This study seeks to assess various aspects of patient recovery and overall health to ascertain the potential positive impact of this intervention on the posttransplantation course.
ResultsThe process of patient recruitment for this study is scheduled to commence subsequent to a site initiation visit, which was slated to take place on August 28, 2023. The primary outcome measure that will be assessed in this research endeavor is the oxygenation ratio, a metric denoted as the highest PaO2/FiO2 ratio achieved by patients within a 72-hour timeframe following their LTx procedure.
ConclusionsWe propose that cytokine filtration could enhance the overall outcomes of LTx. Our hypothesis suggests potential improvements in LTx outcome and patient care.
Trial RegistrationClinicalTrials.gov NCT05526950; https://www.clinicaltrials.gov/study/NCT05526950
International Registered Report Identifier (IRRID)PRR1-10.2196/52553 |
| first_indexed | 2024-03-08T23:48:52Z |
| format | Article |
| id | doaj.art-6f224acc1a9e49a1bdc9c10899d58a0c |
| institution | Directory Open Access Journal |
| issn | 1929-0748 |
| language | English |
| last_indexed | 2024-03-08T23:48:52Z |
| publishDate | 2023-12-01 |
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| series | JMIR Research Protocols |
| spelling | doaj.art-6f224acc1a9e49a1bdc9c10899d58a0c2023-12-13T13:45:53ZengJMIR PublicationsJMIR Research Protocols1929-07482023-12-0112e5255310.2196/52553Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled TrialSandra Lindstedthttps://orcid.org/0000-0003-4484-6473Martin Silverbornhttps://orcid.org/0009-0008-9913-0062Lukas Lannemyrhttps://orcid.org/0000-0002-8280-5210Leif Pierrehttps://orcid.org/0000-0001-6464-505XHillevi Larssonhttps://orcid.org/0000-0001-6001-2570Edgars Grinshttps://orcid.org/0000-0002-3279-8454Snejana Hyllenhttps://orcid.org/0000-0003-1253-4969Goran Dellgrenhttps://orcid.org/0000-0003-4961-9704Jesper Magnussonhttps://orcid.org/0000-0002-5630-0155 BackgroundLung transplantation (LTx) is the only treatment option for end-stage lung disease. Despite improvements, primary graft dysfunction (PGD) remains the leading cause of early mortality and precipitates chronic lung allograft dysfunction, the main factor in late mortality after LTx. PGD develops within the first 72 hours and impairs the oxygenation capacity of the lung, measured as partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2). Increasing the PaO2/FiO2 ratio is thus critical and has an impact on survival. There is a general lack of effective treatments for PGD. When a transplanted lung is not accepted by the immune system in the recipient, a systemic inflammatory response starts where cytokines play a critical role in initiating, amplifying, and maintaining the inflammation leading to PGD. Cytokine filtration can remove these cytokines from the circulation, thus reducing inflammation. In a proof-of-concept preclinical porcine model of LTx, cytokine filtration improved oxygenation and decreased PGD. In a feasibility study, we successfully treated patients undergoing LTx with cytokine filtration (ClinicalTrials.gov; NCT05242289). ObjectiveThe purpose of this clinical trial is to demonstrate the superiority of cytokine filtration in improving LTx outcome, based on its effects on oxygenation ratio, plasma levels of inflammatory markers, PGD incidence and severity, lung function, kidney function, survival, and quality of life compared with standard treatment with no cytokine filtration. MethodsThis study is a Swedish national interventional randomized controlled trial involving 116 patients. Its primary objective is to investigate the potential benefits of cytokine filtration when used in conjunction with LTx. Specifically, this study aims to determine whether the application of cytokine filtration, administered for a duration of 12 hours within the initial 24 hours following a LTx procedure, can lead to improved patient outcomes. This study seeks to assess various aspects of patient recovery and overall health to ascertain the potential positive impact of this intervention on the posttransplantation course. ResultsThe process of patient recruitment for this study is scheduled to commence subsequent to a site initiation visit, which was slated to take place on August 28, 2023. The primary outcome measure that will be assessed in this research endeavor is the oxygenation ratio, a metric denoted as the highest PaO2/FiO2 ratio achieved by patients within a 72-hour timeframe following their LTx procedure. ConclusionsWe propose that cytokine filtration could enhance the overall outcomes of LTx. Our hypothesis suggests potential improvements in LTx outcome and patient care. Trial RegistrationClinicalTrials.gov NCT05526950; https://www.clinicaltrials.gov/study/NCT05526950 International Registered Report Identifier (IRRID)PRR1-10.2196/52553https://www.researchprotocols.org/2023/1/e52553 |
| spellingShingle | Sandra Lindstedt Martin Silverborn Lukas Lannemyr Leif Pierre Hillevi Larsson Edgars Grins Snejana Hyllen Goran Dellgren Jesper Magnusson Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial JMIR Research Protocols |
| title | Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial |
| title_full | Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial |
| title_fullStr | Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial |
| title_full_unstemmed | Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial |
| title_short | Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial |
| title_sort | design and rationale of cytokine filtration in lung transplantation glusorb protocol for a multicenter clinical randomized controlled trial |
| url | https://www.researchprotocols.org/2023/1/e52553 |
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