{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:34:08Z","timestamp":1793406848053,"version":"4.5.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl Int"],"abstract":"<jats:p>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\u2013recipient 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.<\/jats:p>","DOI":"10.3389\/ti.2024.13886","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T04:17:57Z","timestamp":1736137077000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus"],"prefix":"10.3389","volume":"37","author":[{"given":"Lucrezia","family":"Furian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Heemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Bengtsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriol","family":"Bestard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Binet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg A.","family":"B\u00f6hmig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Boletis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Briggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans H. J.","family":"Claas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Couzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Cozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Crespo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiko P. J.","family":"De Vries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fritz","family":"Diekmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Durlik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Glotz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilkka","family":"Helantera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley C.","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Kuypers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Lefaucheur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Legendre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Lorant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Maggiore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizam","family":"Mamode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smaragdi","family":"Marinaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annick","family":"Massart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Oberbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"Renders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Roelen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Luc","family":"Taupin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ond\u0159ej","family":"Viklick\u00fd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeliki","family":"Vittoraki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelies E.","family":"de Weerd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Naesens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1097\/TP.0000000000004687","article-title":"Immunized Patients Face Reduced Access to Transplantation in the Eurotransplant Kidney Allocation System","volume":"107","author":"De Ferrante","year":"2023","journal-title":"Transplantation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1097\/TP.0000000000002737","article-title":"Desensitization in the Era of Precision Medicine: Moving from the Bench to Bedside","volume":"103","author":"Habal","year":"2019","journal-title":"Transplantation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1097\/TP.0000000000002989","article-title":"Posttransplant Outcomes for cPRA-100% Recipients under the New Kidney Allocation System","volume":"104","author":"Jackson","year":"2020","journal-title":"Transplantation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e13751","DOI":"10.1111\/CTR.13751","article-title":"Managing Highly Sensitized Renal Transplant Candidates in the Era of Kidney Paired Donation and the New Kidney Allocation System: Is There Still a Role for Desensitization?","volume":"33","author":"Schinstock","year":"2019","journal-title":"Clin Transpl"},{"key":"B5","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/TP.0000000000003095","article-title":"Recommended Treatment for Antibody-Mediated Rejection after Kidney Transplantation: The 2019 Expert Consensus from the Transplantation Society Working Group","volume":"104","author":"Schinstock","year":"2020","journal-title":"Transplantation"},{"key":"B6","doi-asserted-by":"publisher","first-page":"684","DOI":"10.2215\/CJN.05930615","article-title":"Approach to the Highly Sensitized Kidney Transplant Candidate","volume":"11","author":"Keith","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.2165\/11631110-000000000-00000","article-title":"Identification and Therapeutic Management of Highly Sensitized Patients Undergoing Renal Transplantation","volume":"72","author":"Huber","year":"2012","journal-title":"Drugs"},{"key":"B8","doi-asserted-by":"publisher","first-page":"10511","DOI":"10.3389\/TI.2022.10511","article-title":"European Guideline for the Management of Kidney Transplant Patients with HLA Antibodies: By the European Society for Organ Transplantation Working Group","volume":"35","author":"Mamode","year":"2022","journal-title":"Transpl Int"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1111\/AJT.13770","article-title":"Changes in Deceased Donor Kidney Transplantation One Year after KAS Implementation","volume":"16","author":"Stewart","year":"2016","journal-title":"Am J Transpl"},{"key":"B10","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/TP.0000000000004262","article-title":"Seeking Standardized Definitions for HLA-Incompatible Kidney Transplants: A Systematic Review","volume":"107","author":"Jatana","year":"2022","journal-title":"Transplantation"},{"key":"B11","volume-title":"Long-term Follow up of Imlifidase Desensitized Kidney Transplant Recipients: 5-year Pooled Analysis","author":"Maldonado","year":"2024"},{"key":"B12","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1097\/TP.0B013E3181B04A5F","article-title":"Enhanced Kidney Allocation to Highly Sensitized Patients by the Acceptable Mismatch Program","volume":"88","author":"Claas","year":"2009","journal-title":"Transplantation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1097\/SLA.0000000000002924","article-title":"IdeS (Imlifidase): A Novel Agent that Cleaves Human IgG and Permits Successful Kidney Transplantation across High-Strength Donor-specific Antibody","volume":"268","author":"Lonze","year":"2018","journal-title":"Ann Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"12475","DOI":"10.3389\/ti.2024.12475","article-title":"European Consensus on the Management of Sensitized Kidney Transplant Recipients: A Delphi Study","volume":"37","author":"Furian","year":"2024","journal-title":"Transpl Int"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3907","DOI":"10.1111\/ajt.16754","article-title":"Outcomes at 3 Years Posttransplant in Imlifidase-Desensitized Kidney Transplant Patients","volume":"21","author":"Kjellman","year":"2021","journal-title":"Am J Transplant"},{"key":"B16","doi-asserted-by":"publisher","first-page":"922","DOI":"10.2215\/CJN.08140910","article-title":"Desensitization Protocols and Their Outcome","volume":"6","author":"Marfo","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1111\/TRI.13269","article-title":"Outcome of the Risk-Stratified Desensitization Protocol in Donor-specific Antibody-Positive Living Kidney Transplant Recipients: A Retrospective Study","volume":"31","author":"Okada","year":"2018","journal-title":"Transpl Int"},{"key":"B18","doi-asserted-by":"publisher","first-page":"6804678","DOI":"10.1155\/2017\/6804678","article-title":"Desensitization: Overcoming the Immunologic Barriers to Transplantation","volume":"2017","author":"Sethi","year":"2017","journal-title":"J Immunol Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1097\/TP.0000000000003023","article-title":"Imlifidase Inhibits HLA Antibody-Mediated NK Cell Activation and Antibody-dependent Cell-Mediated Cytotoxicity (ADCC) In Vitro","volume":"104","author":"Ge","year":"2020","journal-title":"Transplantation"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1056\/NEJMc1711335","article-title":"IgG Endopeptidase in Highly Sensitized Patients Undergoing Transplantation","volume":"377","author":"Jordan","year":"2017","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2752","DOI":"10.1111\/AJT.14733","article-title":"Safety, Immunogenicity, Pharmacokinetics, and Efficacy of Degradation of Anti-HLA Antibodies by IdeS (Imlifidase) in Chronic Kidney Disease Patients","volume":"18","author":"Lorant","year":"2018","journal-title":"Am J Transpl"},{"key":"B22","unstructured":"Idefirix\u00ae Public Assessment Report (EPAR)2020"},{"key":"B23","unstructured":"Idefirix\u00ae 11 Mg Powder for Concentrate for Solution for Infusion SmPC2024"},{"key":"B24","doi-asserted-by":"publisher","first-page":"11244","DOI":"10.3389\/TI.2023.11244","article-title":"Imlifidase for Kidney Transplantation of Highly Sensitized Patients with a Positive Crossmatch: The French Consensus Guidelines","volume":"36","author":"Couzi","year":"2023","journal-title":"Transpl Int"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/S41073-022-00122-0","article-title":"ACCORD Guideline for Reporting Consensus-Based Methods in Biomedical Research and Clinical Practice: A Study Protocol","volume":"7","author":"Gattrell","year":"2022","journal-title":"Res Integr Peer Rev"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.51936\/fcfm6982","article-title":"Delphi Method: Strengths and Weaknesses","volume":"16","author":"Fink-Hafner","year":"2019","journal-title":"Metodolo\u0161ki zvezki"},{"key":"B27","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/S11096-016-0257-X","article-title":"How to Use the Nominal Group and Delphi Techniques","volume":"38","author":"McMillan","year":"2016","journal-title":"Int J Clin Pharm"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e78","DOI":"10.1016\/J.KISU.2019.11.006","article-title":"The Role of Kidney Transplantation as a Component of Integrated Care for Chronic Kidney Disease","volume":"10","author":"O\u2019Connell","year":"2020","journal-title":"Kidney Int Suppl (2011)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"38","DOI":"10.6002\/ECT.MESOT2018.L41","article-title":"Anti-HLA Antibody: The Role of Epitopes in Organ Transplantation","volume":"17","author":"Argani","year":"2019","journal-title":"Exp Clin Transpl"},{"key":"B30","doi-asserted-by":"publisher","first-page":"11321","DOI":"10.3389\/TI.2023.11321","article-title":"The Clinical Utility of Post-Transplant Monitoring of Donor-specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report with Guideline Statements for Clinical Practice","volume":"36","author":"van den Broek","year":"2023","journal-title":"Transpl Int"},{"key":"B31","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/S00281-011-0259-7","article-title":"Steroids in Kidney Transplant Patients","volume":"33","author":"Steiner","year":"2011","journal-title":"Semin Immunopathol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1002\/CPT.2915","article-title":"Tacrolimus and Mycophenolic Acid Exposure Are Associated with Biopsy-Proven Acute Rejection: A Study to Provide Evidence for Longer-Term Target Ranges","volume":"114","author":"Meziyerh","year":"2023","journal-title":"Clin Pharmacol Ther"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e448","DOI":"10.1097\/TXD.0000000000000888","article-title":"Impact of Cold Ischemia Time on Outcomes of Deceased Donor Kidney Transplantation: An Analysis of a National Registry","volume":"5","author":"Peters-Sengers","year":"2019","journal-title":"Transpl Direct"},{"key":"B34","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1016\/J.HUMIMM.2019.04.019","article-title":"The ABCs (DRDQDPs) of the Prozone Effect in Single Antigen Bead HLA Antibody Testing: Lessons from Our Highly Sensitized Patients","volume":"80","author":"Greenshields","year":"2019","journal-title":"Hum Immunol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/TRI.12217","article-title":"Factors Influencing Long-Term Outcome after Kidney Transplantation","volume":"27","author":"Legendre","year":"2014","journal-title":"Transpl Int"},{"key":"B36","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1097\/01.TP.0000438026.03958.7B","article-title":"Recipient Age and Risk for Mortality after Kidney Transplantation in England","volume":"97","author":"Karim","year":"2014","journal-title":"Transplantation"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1097\/TP.0000000000002931","article-title":"Recipient Comorbidity and Survival Outcomes after Kidney Transplantation: A UK-wide Prospective Cohort Study","volume":"104","author":"Wu","year":"2020","journal-title":"Transplantation"},{"key":"B38","unstructured":"Imlifidase for Preventing Kidney Transplant Rejection in People with Chronic Kidney Disease (ID1672)2022"},{"key":"B39","doi-asserted-by":"publisher","first-page":"833","DOI":"10.3389\/FIMMU.2020.00833","article-title":"Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet","volume":"11","author":"von Moos","year":"2020","journal-title":"Front Immunol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"h3557","DOI":"10.1136\/BMJ.H3557","article-title":"Long Term Outcomes of Transplantation Using Kidneys from Expanded Criteria Donors: Prospective, Population Based Cohort Study","volume":"351","author":"Aubert","year":"2015","journal-title":"BMJ"},{"key":"B41","doi-asserted-by":"publisher","first-page":"w13668","DOI":"10.4414\/SMW.2012.13668","article-title":"HLA and Non-HLA Polymorphisms in Renal Transplantation","volume":"142","author":"Laperrousaz","year":"2012","journal-title":"Swiss Med Wkly"},{"key":"B42","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1056\/NEJMRA2014530","article-title":"Long-Term Survival after Kidney Transplantation","volume":"385","author":"Hariharan","year":"2021","journal-title":"N Engl J Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/J.AJT.2023.10.016","article-title":"The Banff 2022 Kidney Meeting Report: Reappraisal of Microvascular Inflammation and the Role of Biopsy-Based Transcript Diagnostics","volume":"24","author":"Naesens","year":"2024","journal-title":"Am J Transplant"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2024.13886\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T15:42:57Z","timestamp":1736523777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2024.13886\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":43,"alternative-id":["10.3389\/ti.2024.13886"],"URL":"https:\/\/doi.org\/10.3389\/ti.2024.13886","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]},"article-number":"13886"}}