AUTHOR=Furian Lucrezia , Heemann Uwe , Bengtsson Mats , Bestard Oriol , Binet Isabelle , Böhmig Georg A. , Boletis John , Briggs David , Claas Frans H. J. , Couzi Lionel , Cozzi Emanuele , Crespo Marta , De Vries Aiko P. J. , Diekmann Fritz , Durlik Magdalena , Glotz Denis , Helantera Ilkka , Jackson Annette , Jordan Stanley C. , Kuypers Dirk , Lefaucheur Carmen , Legendre Christophe , Lorant Tomas , Maggiore Umberto , Mamode Nizam , Marinaki Smaragdi , Massart Annick , Müller Thomas , Oberbauer Rainer , Renders Lutz , Roelen Dave , Taupin Jean-Luc , Viklický Ondřej , Vittoraki Angeliki , de Weerd Annelies E. , Naesens Maarten TITLE=Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus JOURNAL=Transplant International VOLUME=37 YEAR=2025 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.13886 DOI=10.3389/ti.2024.13886 ISSN=1432-2277 ABSTRACT=

Highly sensitized (HS) patients in need of kidney transplantation (KTx) typically spend a longer time waiting for compatible kidneys, are unlikely to receive an organ offer, and are at increased risk of antibody-mediated rejection (AMR). Desensitization using imlifidase, which is more rapid and removes total body immunoglobulin G (IgG) to a greater extent than other methods, enables transplantation to occur between HLA-incompatible (HLAi) donor–recipient pairs and allows patients to have greater access to KTx. However, when the project was launched there was limited data and clinical experience with desensitization in general and with imlifidase specifically. Hence, this Delphi methodology was used to reach a consensus from a multi-disciplinary team (MDT) of experts from 15 countries on the management of HS patients undergoing imlifidase HLAi from a deceased donor (DD) KTx. This Delphi consensus provides clinical practice guidance on the use of imlifidase in the end-to-end management of HS patients undergoing an HLAi DD KTx and supports centers in the development of guidelines for the utilization and integration of imlifidase into clinical practice.