Transplant International (Jan 2025)
Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus
- Lucrezia Furian,
- Uwe Heemann,
- Mats Bengtsson,
- Oriol Bestard,
- Isabelle Binet,
- Georg A. Böhmig,
- John Boletis,
- David Briggs,
- Frans H. J. Claas,
- Lionel Couzi,
- Emanuele Cozzi,
- Marta Crespo,
- Aiko P. J. De Vries,
- Fritz Diekmann,
- Magdalena Durlik,
- Denis Glotz,
- Ilkka Helantera,
- Annette Jackson,
- Stanley C. Jordan,
- Dirk Kuypers,
- Dirk Kuypers,
- Carmen Lefaucheur,
- Christophe Legendre,
- Tomas Lorant,
- Umberto Maggiore,
- Nizam Mamode,
- Smaragdi Marinaki,
- Annick Massart,
- Thomas Müller,
- Rainer Oberbauer,
- Lutz Renders,
- Dave Roelen,
- Jean-Luc Taupin,
- Ondřej Viklický,
- Angeliki Vittoraki,
- Annelies E. de Weerd,
- Maarten Naesens
Affiliations
- Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology DISCOG, University Hospital of Padova, Padova, Italy
- Uwe Heemann
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- Mats Bengtsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Oriol Bestard
- Nephrology and Kidney Transplant Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Isabelle Binet
- Clinic of Nephrology and Transplantation Medicine, Cantonal Hospital St Gallen, St. Gallen, Switzerland
- Georg A. Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
- John Boletis
- Department of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
- David Briggs
- Histocompatibility and Immunogenetics Laboratory, Birmingham Centre, NHS Blood and Transplant, UK NHS Blood and Transplant, Birmingham, United Kingdom
- Frans H. J. Claas
- Eurotransplant Reference Laboratory, Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef, Netherlands
- Lionel Couzi
- 0Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
- Emanuele Cozzi
- 1Transplant Immunology Unit, Department of Cardiac, National Transplant Centre (CNT), Thoracic and Vascular Sciences Padua University Hospital - Ospedale Giustinianeo, Padova, Italy
- Marta Crespo
- 2Department of Nephrology, Hospital del Mar, Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Aiko P. J. De Vries
- 3Division of Nephrology, Department of Medicine, and Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
- Fritz Diekmann
- 4Department of Nephrology and Kidney Transplantation, Hospital Clínic Barcelona, Barcelona, Spain
- Magdalena Durlik
- 5Klinika Transplantologii, Immunologii, Nefrologii i Chorób Wewnętrznych Warszawski Uniwersytet Medyczny ul, Warszawa, Poland
- Denis Glotz
- 6Department of Nephrology and Renal Transplantation, Saint-Louis Hospital in Paris, Paris, France
- Ilkka Helantera
- 7Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Annette Jackson
- 8Department of Surgery, Duke University, Durham, NC, United States
- Stanley C. Jordan
- 9Nephrology 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
- Dirk Kuypers
- 0Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
- Dirk Kuypers
- 1Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Carmen Lefaucheur
- 2Nephrologist and Head of the Nephrology and Kidney Transplantation Department, Saint-Louis Hospital-APHP, Paris, France
- Christophe Legendre
- 3Nephrology at Université Paris Cité and Head of Nephrology and Transplantation Unit at Necker Hospital in Paris, Paris, France
- Tomas Lorant
- 4Uppsala University, Department of Surgical Sciences, Section of Transplant Surgery, Uppsala, Sweden
- Umberto Maggiore
- 5Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia - Trapianti Rene Pancreas, Programma Regionale Trapianti Emilia-Romagna, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Nizam Mamode
- 6Department of Transplantation, Transplant Surgery at Guy’s and Great Ormond Street Hospitals, London, United Kingdom
- Smaragdi Marinaki
- 7National and Kapodistrian University of Athens, Clinic of Nephrology and Transplantation, “Laiko” General Hospital, Athens, Greece
- Annick Massart
- 8Department of Nephrology, UZ Antwerpen, Antwerpen, Belgium
- Thomas Müller
- 9Clinic for Nephrology, Renal Transplant Program, Transplant Institute, University Hospital Zurich, Zurich, Switzerland
- Rainer Oberbauer
- 0Medical University of Vienna, Vienna, Austria
- Lutz Renders
- 1Department of Nephrology of Technische Universität München, München (TUM), Munich, Germany
- Dave Roelen
- 2Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
- Jean-Luc Taupin
- 3Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, APHP Paris, Paris, France
- Ondřej Viklický
- 4Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Angeliki Vittoraki
- 5Immunology Department and National Tissue Typing Center, “G.Gennimatas” Hospital, Athens, Greece
- Annelies E. de Weerd
- 6Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, Netherlands
- Maarten Naesens
- 1Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- DOI
- https://doi.org/10.3389/ti.2024.13886
- Journal volume & issue
-
Vol. 37
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.
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