TLI- and ATG-Enabled Minimization Protocol in Liver Transplantation (NCT07634562) | Clinical Trial Compass
Not Yet RecruitingPhase 1/2
TLI- and ATG-Enabled Minimization Protocol in Liver Transplantation
United States12 participantsStarted 2026-08
Plain-language summary
The unmet medical need in solid organ transplantation is to eliminate the lifelong requirement of powerful immune suppression drug combinations with their attendant side effects, and to prevent immune mediated rejection of the organ transplant. The proposed trial is designed to study if following a 'standard of care' deceased donor liver transplant host conditioning using Total Lymphoid Irradiation (TLI) and Anti-Tthymocyte Globulin (ATG) will result in operational tolerance and ultimately allow for immunosuppression drug minimization or cessation.
It has been hypothesized that the ATG and TLI conditioning regimen post liver transplant will be safe and well tolerated and will result in recipients successfully being withdrawn from immunosuppression within 2 years after liver transplantation. We will test the hypothesis that by using a conditioning regimen of ATG and TLI to induce this operational tolerance will allow immunosuppressive drug minimization and cessation while maintaining normal graft function and without the risk of graft rejection.
Importance of this knowledge:
Operational tolerance occurs spontaneously in a minority of liver transplant recipients; however, predictable and reproducible induction of tolerance remains an unmet need. Building on extensive experience with TLI-based tolerance induction in kidney transplantation at Stanford, this study aims to evaluate whether a non-myeloablative conditioning regimen using TLI and ATG can safely facilitate immunosuppression minimization and withdrawal in liver transplant recipients without the use of donor hematopoietic cell infusion.
Who can participate
Age range
18 Years – 55 Years
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion Criteria:
* Undergoing liver transplantation at Stanford University
* No contraindications to Total Lymphoid Irradiation or rabbit antithymocyte globulin (rATG)
Exclusion Criteria:
* Contraindications to Total Lymphoid Irradiation (e.g. pregnancy, bone marrow suppression or disease, autoimmune disease, prior radiation in the field)
* Contraindications to rATG
* Patients with history of hepatocellular carcinoma (HCC) or other malignancies with exception of non melanoma skin cancer in remission Model of End-Stage Liver Disease (MELD) score \> 25 Liver transplants with severe reperfusion syndrome (hemodynamic instability requiring 3 or more pressors after reperfusion) Liver transplant with early allograft dysfunction (Orloff criteria) Diagnosis of hepatitis B Diagnosis of hepatitis C, except for patients that have been treated and eradicated of hepatitis C Virtual and/or flow crossmatch positive (MFI added up to 8000 for each DSA with MFI\>1000).
Subject has previously received or is receiving another organ for transplant other than liver Subject is currently on dialysis Recipient or donor is HIV positive Subject has received an ABO incompatible donor Subject has received a donor liver greater than 65 years of age Subject has an active infection at the time of transplant Subject will require immunosuppressive agent other than those prescribed in this study Subject is pregnant or lactating Subject is unlikely to comply with the visits scheduled in the protocol, incl…
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1Based on my diagnosis and history, is this trial worth exploring for me — or is there a standard treatment we should try first?
2What does this trial's phase tell us about how much is already known about its safety and benefit?
3What would taking part actually involve for me — visits, tests, time, and travel?
4What are the known and possible risks or side effects I should weigh, and how would they be monitored?
5If this trial isn't the right fit, what other options or trials would you suggest I look into?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
What they're measuring
1
The success rate
Timeframe: After intervention through 18 months and monitored monthly up to 36 months.