Risk-adapted HLA delisting and imlifidase-enabled deceased-donor kidney transplantation in highly sensitized kidney transplant candidates: a German expert consensus report - Report - MDSpire

Risk-adapted HLA delisting and imlifidase-enabled deceased-donor kidney transplantation in highly sensitized kidney transplant candidates: a German expert consensus report

  • By

  • Stefan Reuter

  • Louise Benning

  • Andrea Dick

  • Lisa-Marie Dilz

  • Gunilla Einecke

  • Florian Emmerich

  • Florian Grahammer

  • Rebecca Großmann

  • Wilfried Gwinner

  • Fabian Halleck

  • Michael Hallensleben

  • Falko M. Heinemann

  • Bernd Jänigen

  • Dennis Kannenkeril

  • Teresa Kauke

  • Reinhard Kelsch

  • Stephan Kemmner

  • Malte Andreas Kluger

  • Jan Kowald

  • Andreas Kribben

  • Claudia Lehmann

  • Monika Lindemann

  • Giancarlo Maccagno

  • Christian Morath

  • Anja Mühlfeld

  • Lien Pham

  • Lutz Renders

  • Stefan Schaub

  • Sabine Scherer

  • Christian Seidl

  • Bernd Spriewald

  • Dirk Stippel

  • Julian Stumpf

  • Thuong Hien Tran

  • Rolf Weimer

  • Benjamin Wilde

  • Daniel Zecher

  • Malte Ziemann

  • Svitlana Ziganshyna

  • Nils Lachmann

  • Klemens Budde

  • June 9, 2026

  • 0 min

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Clinical Report: HLA Delisting and Imlifidase in Kidney Transplantation

Overview

This report presents consensus guidelines for HLA delisting and the use of imlifidase in kidney transplantation for highly sensitized recipients. It aims to improve transplant opportunities while managing immunological risks.

Background

Kidney transplantation is the preferred treatment for end-stage renal disease, yet highly sensitized patients face significant barriers due to HLA sensitization. The German expert consensus provides a framework to enhance access to transplantation for this vulnerable group, addressing the urgent need for effective strategies in the face of low donor availability.

Data Highlights

No numerical data provided in the source material.

Key Findings

  • The proportion of highly sensitized kidney transplant candidates in the Eurotransplant region increased from 2.0% to 5.6% between 2011 and 2019.
  • Patients with a virtual HLA panel reactivity (vPRA) of at least 99.5% have a significantly reduced probability of receiving a transplant.
  • Desensitization using imlifidase can convert a positive crossmatch to negative, allowing for transplantation opportunities.
  • Long-term follow-up of imlifidase-treated patients shows a 5-year patient survival rate of 90% and a graft survival rate of 82%.
  • Approximately 40% of patients experience clinically manifest antibody-mediated rejection post-transplant.

Clinical Implications

The guidelines emphasize the importance of multidisciplinary governance in candidate selection and the need for structured monitoring and management of antibody-mediated rejection. Experienced transplant centers are encouraged to adopt these recommendations to optimize outcomes for highly sensitized patients.

Conclusion

The consensus guidelines aim to balance transplant opportunities against immunological risks for highly sensitized kidney transplant candidates, enhancing their chances for successful transplantation.

Related Resources & Content

  1. German Transplantation Society, Frontiers in Immunology, 2026 -- HLA Delisting Based on Risk and Imlifidase-Enhanced Kidney Transplantation
  2. Bone Marrow Transplantation — HLA matching in contemporary haematopoietic cell transplantation: Recommendations from the EBMT Practice Harmonisation and Guidelines Committee
  3. the asco post — HLA-Matching Considerations for Hematopoietic Cell Transplantation in Hematologic Malignancies
  4. Journal of Gastroenterology — Liver Transplantation from Living Donors with Positive Sensitized Lymphocytotoxic Crossmatch
  5. Bone Marrow Transplantation — Guidelines from the EBMT/ESID Working Group on Hematopoietic Stem Cell Transplantation for Inborn Errors of Immunity
  6. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation
  7. Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus
  8. Frontiers | Risk-adapted HLA delisting and imlifidase-enabled deceased-donor kidney transplantation in highly sensitized kidney transplant candidates: a German expert consensus report
  9. Frontiers Publishing Partnerships | Five Years Follow-up of Imlifidase Desensitized Kidney Transplant Recipients
  10. Idefirix | European Medicines Agency (EMA)
  11. ORIGINAL RESEARCH

Original Source(s)

Risk-adapted HLA delisting and imlifidase-enabled deceased-donor kidney transplantation in highly sensitized kidney transplant candidates: a German expert consensus report

  • by Stefan Reuter, Louise Benning, Andrea Dick, Lisa-Marie Dilz, Gunilla Einecke, Florian Emmerich, Florian Grahammer, Rebecca Großmann, Wilfried Gwinner, Fabian Halleck, Michael Hallensleben, Falko M. Heinemann, Bernd Jänigen, Dennis Kannenkeril, Teresa Kauke, Reinhard Kelsch, Stephan Kemmner, Malte Andreas Kluger, Jan Kowald, Andreas Kribben, Claudia Lehmann, Monika Lindemann, Giancarlo Maccagno, Christian Morath, Anja Mühlfeld, Lien Pham, Lutz Renders, Stefan Schaub, Sabine Scherer, Christian Seidl, Bernd Spriewald, Dirk Stippel, Julian Stumpf, Thuong Hien Tran, Rolf Weimer, Benjamin Wilde, Daniel Zecher, Malte Ziemann, Svitlana Ziganshyna, Nils Lachmann, Klemens Budde

  • June 9, 2026

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