Study to Improve Renal Function After Kidney Transplantation

Delayed graft function (DGF) is generally defined as the need for dialysis during the first
7 days after transplantation although the definition can also include failure to improve
preexisting renal function. DGF is an important problem in renal allograft transplantation
that affects approximately 25% of transplanted cadaveric kidneys. It has generally been
observed that delayed graft function has been associated with reduced graft survival. In
addition to an association of DGF with graft loss, DGF imposes an economic burden due to
prolonged hospitalization and dialysis. The strongest association with occurrence of DGF is
ischemia around the time of transplantation. Aside from approaches to minimize ischemia
time and use of antibody induction, there are no good specific therapeutic options to
prevent or treat delayed graft function. This study is designed to evaluate the safety and
activity of an investigational drug in improving renal function in patients who have
undergone renal transplantation and have signs and symptoms of significant renal injury and
are at risk for dialysis.

Inclusion Criteria:

1. Males and females ≥ 18 years of age

2. Had renal transplantation due to end stage disease requiring chronic dialysis

3. Study drug can be administered within 36 hours after transplantation

4. Received kidney from healthy donor or donor with history of diabetes mellitus or
hypertension

5. Donor terminal serum creatinine ≤ 2.2 mg/dL.

6. No urine output, OR average urine output of < 50 cc/H over 8 or more consecutive
hours, OR normal urine output following transplantation that diminished to average of
< 50 cc/H over 8 or more consecutive hours, OR creatinine reduction ratio at 24
hours after transplantation to pre-transplantation is < 30%.

7. Reason for low urine output is unlikely due to structural changes. If clinically
indicated, an ultrasound will be performed

8. Dry weight to< 120kg and BMI <35

9. Women of child bearing potential have a negative serum pregnancy test prior to
transplantation.

10. Women of child bearing potential (including perimenopausal women who have had a
menstrual period within 1 year) must agree to use 2 forms of effective birth control
regimen (at least one-barrier method) during the 28-day study period. Men must agree
to use condoms during the 28-day study period.

11. In the opinion of the investigator, the subject is capable of understanding and
complying with the protocol.

12. Subjects must have signed the informed consent document prior to performance of any
study related procedure including screening procedure.

Exclusion Criteria:

1. Subject with normal urine output and not requiring dialysis prior to renal
transplantation (i.e., had pre-emptive renal transplantation).

2. Signs and symptoms of volume depletion.

3. Recipient of multiple organ transplantation or scheduled for multiple organ
transplantation.

4. Recipient of pediatric en-bloc kidney transplantation.

5. Recipient of kidney with cold ischemia time > 40 hours

6. Has measurable donor-specific antibody or positive cross-match requiring deviation
from standard immunosuppressive therapy.

7. Currently participating in or has participated in an investigational drug or medical
device study within 30 days or five half-lives, whichever is longer, prior to
enrollment into this study.

8. Concurrent sepsis or active bacterial infection.

9. Have an active malignancy or history of solid, metastatic or hematologic malignancy
with the exception of basal or squamous cell carcinoma of the skin that has been
removed.

10. Women of child bearing potential who are breast feeding.

11. History of positive HIV test.

12. History of rheumatoid arthritis.

13. Subjects who require the cytochrome P450 1A2 (CYP1A2) inhibitors, ciprofloxacin
and/or fluvoxamine (Luvox®)

14. Subject is unwilling or unable to comply with the protocol or to cooperate fully with
the Investigator or the site personnel.

15. Subject is not deemed medically stable for the study in the opinion of the
Investigator or the subject's primary nephrologist.