. 2025 Jan 6:37:13886.

doi: 10.3389/ti.2024.13886. eCollection 2024.

Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus

Lucrezia Furian¹, Uwe Heemann², Mats Bengtsson³, Oriol Bestard⁴, Isabelle Binet⁵, Georg A Böhmig⁶, John Boletis⁷, David Briggs⁸, Frans H J Claas⁹, Lionel Couzi¹⁰, Emanuele Cozzi¹¹, Marta Crespo¹², Aiko P J De Vries¹³, Fritz Diekmann¹⁴, Magdalena Durlik¹⁵, Denis Glotz¹⁶, Ilkka Helantera¹⁷, Annette Jackson¹⁸, Stanley C Jordan¹⁹, Dirk Kuypers^{20

21}, Carmen Lefaucheur²², Christophe Legendre²³, Tomas Lorant²⁴, Umberto Maggiore²⁵, Nizam Mamode²⁶, Smaragdi Marinaki²⁷, Annick Massart²⁸, Thomas Müller²⁹, Rainer Oberbauer³⁰, Lutz Renders³¹, Dave Roelen³², Jean-Luc Taupin³³, Ondřej Viklický³⁴, Angeliki Vittoraki³⁵, Annelies E de Weerd³⁶, Maarten Naesens²¹

Affiliations

¹ Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology DISCOG, University Hospital of Padova, Padova, Italy.
² Abteilung für Nephrologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
³ Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
⁴ Nephrology and Kidney Transplant Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁵ Clinic of Nephrology and Transplantation Medicine, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
⁶ Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria.
⁷ Department of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece.
⁸ Histocompatibility and Immunogenetics Laboratory, Birmingham Centre, NHS Blood and Transplant, UK NHS Blood and Transplant, Birmingham, United Kingdom.
⁹ Eurotransplant Reference Laboratory, Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef, Netherlands.
¹⁰ Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.
¹¹ Transplant Immunology Unit, Department of Cardiac, National Transplant Centre (CNT), Thoracic and Vascular Sciences Padua University Hospital - Ospedale Giustinianeo, Padova, Italy.
¹² Department of Nephrology, Hospital del Mar, Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain.
¹³ Division of Nephrology, Department of Medicine, and Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands.
¹⁴ Department of Nephrology and Kidney Transplantation, Hospital Clínic Barcelona, Barcelona, Spain.
¹⁵ Klinika Transplantologii, Immunologii, Nefrologii i Chorób Wewnętrznych Warszawski Uniwersytet Medyczny ul, Warszawa, Poland.
¹⁶ Department of Nephrology and Renal Transplantation, Saint-Louis Hospital in Paris, Paris, France.
¹⁷ Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹⁸ Department of Surgery, Duke University, Durham, NC, United States.
¹⁹ Nephrology and Transplant Immunology Medical Director Kidney Transplant Program Cedars-Sinai Medical Center, Pediatrics and Medicine David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
²⁰ Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
²¹ Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
²² Nephrologist and Head of the Nephrology and Kidney Transplantation Department, Saint-Louis Hospital-APHP, Paris, France.
²³ Nephrology at Université Paris Cité and Head of Nephrology and Transplantation Unit at Necker Hospital in Paris, Paris, France.
²⁴ Uppsala University, Department of Surgical Sciences, Section of Transplant Surgery, Uppsala, Sweden.
²⁵ Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia - Trapianti Rene Pancreas, Programma Regionale Trapianti Emilia-Romagna, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
²⁶ Department of Transplantation, Transplant Surgery at Guy's and Great Ormond Street Hospitals, London, United Kingdom.
²⁷ National and Kapodistrian University of Athens, Clinic of Nephrology and Transplantation, "Laiko" General Hospital, Athens, Greece.
²⁸ Department of Nephrology, UZ Antwerpen, Antwerpen, Belgium.
²⁹ Clinic for Nephrology, Renal Transplant Program, Transplant Institute, University Hospital Zurich, Zurich, Switzerland.
³⁰ Medical University of Vienna, Vienna, Austria.
³¹ Department of Nephrology of Technische Universität München, München (TUM), Munich, Germany.
³² Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.
³³ Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, APHP Paris, Paris, France.
³⁴ Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czechia.
³⁵ Immunology Department and National Tissue Typing Center, "G.Gennimatas" Hospital, Athens, Greece.
³⁶ Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, Netherlands.

PMID: 39867871
PMCID: PMC11758882
DOI: 10.3389/ti.2024.13886

Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus

Lucrezia Furian et al. Transpl Int. 2025.

. 2025 Jan 6:37:13886.

doi: 10.3389/ti.2024.13886. eCollection 2024.

Authors

Affiliations

¹ Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology DISCOG, University Hospital of Padova, Padova, Italy.
² Abteilung für Nephrologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
³ Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
⁴ Nephrology and Kidney Transplant Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁵ Clinic of Nephrology and Transplantation Medicine, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
⁶ Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria.
⁷ Department of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece.
⁸ Histocompatibility and Immunogenetics Laboratory, Birmingham Centre, NHS Blood and Transplant, UK NHS Blood and Transplant, Birmingham, United Kingdom.
⁹ Eurotransplant Reference Laboratory, Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef, Netherlands.
¹⁰ Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.
¹¹ Transplant Immunology Unit, Department of Cardiac, National Transplant Centre (CNT), Thoracic and Vascular Sciences Padua University Hospital - Ospedale Giustinianeo, Padova, Italy.
¹² Department of Nephrology, Hospital del Mar, Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain.
¹³ Division of Nephrology, Department of Medicine, and Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands.
¹⁴ Department of Nephrology and Kidney Transplantation, Hospital Clínic Barcelona, Barcelona, Spain.
¹⁵ Klinika Transplantologii, Immunologii, Nefrologii i Chorób Wewnętrznych Warszawski Uniwersytet Medyczny ul, Warszawa, Poland.
¹⁶ Department of Nephrology and Renal Transplantation, Saint-Louis Hospital in Paris, Paris, France.
¹⁷ Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹⁸ Department of Surgery, Duke University, Durham, NC, United States.
¹⁹ Nephrology and Transplant Immunology Medical Director Kidney Transplant Program Cedars-Sinai Medical Center, Pediatrics and Medicine David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
²⁰ Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
²¹ Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
²² Nephrologist and Head of the Nephrology and Kidney Transplantation Department, Saint-Louis Hospital-APHP, Paris, France.
²³ Nephrology at Université Paris Cité and Head of Nephrology and Transplantation Unit at Necker Hospital in Paris, Paris, France.
²⁴ Uppsala University, Department of Surgical Sciences, Section of Transplant Surgery, Uppsala, Sweden.
²⁵ Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia - Trapianti Rene Pancreas, Programma Regionale Trapianti Emilia-Romagna, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
²⁶ Department of Transplantation, Transplant Surgery at Guy's and Great Ormond Street Hospitals, London, United Kingdom.
²⁷ National and Kapodistrian University of Athens, Clinic of Nephrology and Transplantation, "Laiko" General Hospital, Athens, Greece.
²⁸ Department of Nephrology, UZ Antwerpen, Antwerpen, Belgium.
²⁹ Clinic for Nephrology, Renal Transplant Program, Transplant Institute, University Hospital Zurich, Zurich, Switzerland.
³⁰ Medical University of Vienna, Vienna, Austria.
³¹ Department of Nephrology of Technische Universität München, München (TUM), Munich, Germany.
³² Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.
³³ Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, APHP Paris, Paris, France.
³⁴ Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czechia.
³⁵ Immunology Department and National Tissue Typing Center, "G.Gennimatas" Hospital, Athens, Greece.
³⁶ Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, Netherlands.

PMID: 39867871
PMCID: PMC11758882
DOI: 10.3389/ti.2024.13886

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.

Keywords: HLA incompatible; HLAi; desensitization; imlifidase; kidney transplantation.

Copyright © 2025 Furian, Heemann, Bengtsson, Bestard, Binet, Böhmig, Boletis, Briggs, Claas, Couzi, Cozzi, Crespo, De Vries, Diekmann, Durlik, Glotz, Helantera, Jackson, Jordan, Kuypers, Lefaucheur, Legendre, Lorant, Maggiore, Mamode, Marinaki, Massart, Müller, Oberbauer, Renders, Roelen, Taupin, Viklický, Vittoraki, de Weerd and Naesens.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**FIGURE 1**
The six sections of the Delphi questionnaire that evaluated the various aspects of kidney transplantation and the utilization of imlifidase.

See this image and copyright information in PMC

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Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus

Affiliations

Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus

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